MEDICARE: TATUM NEWBILL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	59121168	VA
2	122300000X	Dentist	12014	NC
3	122300000X	Dentist	11257	SC

General Provider Information

NPI Number	:	1215565833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATUM NEWBILL

Provider Business Mailing Address
First Line	:	18228 MCKEE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-0154
Country	:	US
Telephone Number	:	540-420-7595
Fax Number	:

Provider Business Practice Location Address
First Line	:	244 LATITUDE LN STE 103
Second Line	:
City	:	CLOVER
State	:	SC
Zip	:	29710-8125
Country	:	US
Telephone Number	:	803-831-2171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2020
Last Update Date	:	01/29/2026

Similar Medicare Providers

1710662341 — SANDALWOOD MENTAL HEALTH, PLLC
Practice Location Address:

244 LATITUDE LN STE 104
LAKE WYLIE, SC
29710-8125

Practice Phone: 803-809-3184
Practice Fax: 803-615-4662

1235766338 — PETER A. BERTELLI MSN, APRN, PMHNP-BC
Practice Location Address:

244 LATITUDE LN STE 104
LAKE WYLIE, SC
29710-8125

Practice Phone: 803-809-3184
Practice Fax: 803-615-4662

1528635604 — DR. ARIEL N. KUNDE DMD
Practice Location Address:

244 LATITUDE LN STE 103
LAKE WYLIE, SC
29710-8125

Practice Phone: 803-831-2171
Practice Fax:

1629749106 — CAROLINA FAMILY DENTISTRY AT LAKE WYLIE
Practice Location Address:

244 LATITUDE LN STE 103
LAKE WYLIE, SC
29710-8125

Practice Phone: 803-831-2171
Practice Fax: 803-831-2172

1508733825 — MODLIN & LONDRY XVI DDS LLC
Practice Location Address:

244 LATITUDE LN STE 103
LAKE WYLIE, SC
29710-8125

Practice Phone: 803-831-2171
Practice Fax:

1265366140 — ABHINAYA MURALIDHARAN PERUMBEDU
Practice Location Address:

104 S MAIN ST
CLOVER, SC
29710-1419

Practice Phone: 803-335-3737
Practice Fax:

Directions to “ TATUM NEWBILL ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.