Healthcare Provider Details

I. General information

NPI: 1215565833
Provider Name (Legal Business Name): TATUM NEWBILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 LATITUDE LN STE 103
CLOVER SC
29710-8125
US

IV. Provider business mailing address

18228 MCKEE RD
CHARLOTTE NC
28278-0154
US

V. Phone/Fax

Practice location:
  • Phone: 803-831-2171
  • Fax:
Mailing address:
  • Phone: 540-420-7595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number59121168
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12014
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11257
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: