Healthcare Provider Details

I. General information

NPI: 1851889976
Provider Name (Legal Business Name): TAMMI FULGHAM LAWRENCE P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N PAULINE ST
MEMPHIS TN
38104-1005
US

IV. Provider business mailing address

1717 TIMBER CREEK DR
HERNANDO MS
38632-1540
US

V. Phone/Fax

Practice location:
  • Phone: 256-694-1200
  • Fax:
Mailing address:
  • Phone: 256-694-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00435
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3541
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: