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NPI Code Detail

MEDICARE: DR. MARY TUCKER SESSUMS M.D.

MEDICARE: DR. MARY TUCKER SESSUMS M.D.
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
1207R00000XInternal Medicine Physician3019MN
2207R00000XInternal Medicine PhysicianME133678FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235593096
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY TUCKER SESSUMS M.D.
Provider Business Mailing Address
First Line : 212 W TROY ST STE B
Second Line :
City : DOTHAN
State : AL
Zip : 36303-4455
Country : US
Telephone Number : 904-677-3793
Fax Number : 219-209-5509
Provider Business Practice Location Address
First Line : 212 W TROY ST STE B
Second Line :
City : DOTHAN
State : AL
Zip : 36303-4455
Country : US
Telephone Number : 904-677-3793
Fax Number : 219-209-5509
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2016
Last Update Date : 10/07/2025

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