Provider Demographics
NPI:1740814706
Name:TATUM, DOROTHY JOANN
Entity type:Individual
Prefix:MISS
First Name:DOROTHY
Middle Name:JOANN
Last Name:TATUM
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 1:448 MABE LN
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-3927
Mailing Address - Country:US
Mailing Address - Phone:276-694-6296
Mailing Address - Fax:
Practice Address - Street 1:448 MABE LN
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-3927
Practice Address - Country:US
Practice Address - Phone:276-694-6296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver