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General NPI Number Information
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NPI Number | 1003035080
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Entity Type | Organization
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Legal Business Name | TATUM & TATUM
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 614 AVENUE A
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City | OPELIKA
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State | AL
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Zip | 36801-5062
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Country | US
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Telephone | 334-745-6393
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Fax | 334-749-5290
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Provider Business Mailing Address
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Address Line | 614 AVENUE A P.O. BOX 2326
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City | OPELIKA
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State | AL
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Zip | 36801-5062
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Country | US
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Telephone | 334-745-6393
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Fax | 334-749-5290
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Authorized Official
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Title or Position | OWNER
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Name | DR. CRAWFORD A TATUM JR.
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Credential | D.M.D
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Telephone | 334-745-6393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3200
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License Number State | AL
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