MEDICARE: MRS. TAMALA SURELL STUBBS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	251J00000X	Nursing Care Agency	MS
2	385H00000X	Respite Care	MS
3	251E00000X	Home Health Agency	MS
4	3747P1801X	Personal Care Attendant	MS
5	253Z00000X	In Home Supportive Care Agency	MS
6	376J00000X	Homemaker	MS
7	374U00000X	Home Health Aide	MS

Other Identifiers

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

General Provider Information

NPI Number	:	1942542717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMALA SURELL STUBBS

Provider Business Mailing Address
First Line	:	501A LUMBERTON RD
Second Line	:
City	:	COLUMBIA
State	:	MS
Zip	:	39429-3515
Country	:	US
Telephone Number	:	601-736-9980
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 LUMBERTON RD
Second Line	:
City	:	COLUMBIA
State	:	MS
Zip	:	39429-3515
Country	:	US
Telephone Number	:	601-736-9980
Fax Number	:

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

Provider Enumeration Date	:	03/20/2013
Last Update Date	:	12/03/2025

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