Healthcare Provider Details

I. General information

NPI: 1174576730
Provider Name (Legal Business Name): TOMMIE BRIAN STRETCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SERGEANT PRENTISS DR SUITE 7
NATCHEZ MS
39120-4782
US

IV. Provider business mailing address

55 SGT PRENTISS DR
NATCHEZ MS
39120-4740
US

V. Phone/Fax

Practice location:
  • Phone: 601-445-9543
  • Fax: 601-445-9803
Mailing address:
  • Phone: 601-445-9543
  • Fax: 601-445-9803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12805
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number019243
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101283243
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: