Tatum Medical Clinic

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

16155 Issued in MS

Legal business name

TATUM MEDICAL CLINIC

Practice address

5903 Ridgewood Rd Ste 330
Jackson, MS 39211-3702

Phone

(601) 421-3454

Fax

(601) 899-3920

NPI assigned

Aug 6, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Robert E Tatum, M.D.

Title

Manager

Phone

(601) 421-3454

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1249516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249516800000",
    "number": "1912138967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5903 RIDGEWOOD RD STE 330",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392113702",
            "telephone_number": "601-421-3454",
            "fax_number": "601-899-3920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5903 RIDGEWOOD RD STE 330",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392113702",
            "telephone_number": "601-421-3454",
            "fax_number": "601-899-3920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TATUM MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-06",
        "last_updated": "2009-08-06",
        "status": "A",
        "authorized_official_last_name": "TATUM",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "601-421-3454",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "16155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0120001",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Ashley Tasan, M.D
• Tate Enterprises, LLC
• Diana Rone Tate, M.D.
• Kayla Tate, LMSW
• Siqueta Tate
• Alia Tayara
• George Michael Taybos, DDS
• Ahmed Tayeh, MBBS
• Taylor Coleman, MD, PLLC
• Taylor Roe LCSW PLLC

• Internal Medicine Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Internal Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.