Healthcare Provider Details

I. General information

NPI: 1023088465
Provider Name (Legal Business Name): WILLIAM THOMAS TATUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 PEACHTREE RD NE
ATLANTA GA
30326-1039
US

IV. Provider business mailing address

5130 HENSLEY DR
DUNWOODY GA
30338-4313
US

V. Phone/Fax

Practice location:
  • Phone: 404-842-8852
  • Fax: 404-842-8115
Mailing address:
  • Phone: 770-392-1238
  • Fax: 404-842-8115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number033467
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: