Provider Demographics
NPI:1366033987
Name:TATTERSON, DREWRY GRESHAM
Entity Type:Individual
Prefix:
First Name:DREWRY
Middle Name:GRESHAM
Last Name:TATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 INDEPENDENCE BLVD STE 132
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5476
Mailing Address - Country:US
Mailing Address - Phone:757-497-3900
Mailing Address - Fax:
Practice Address - Street 1:291 INDEPENDENCE BLVD STE 132
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5476
Practice Address - Country:US
Practice Address - Phone:757-497-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2433237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2433OtherDPOR-VA