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General NPI Number Information
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NPI Number | 1124632187
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Entity Type | Individual
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Provider Name | MRS. TATUM MAYFIELD JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 09/06/2020
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 6766 U S HIGHWAY 98
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City | HATTIESBURG
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State | MS
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Zip | 39402-8443
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Country | US
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Telephone | 601-549-4877
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Fax | 601-901-6061
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Provider Business Mailing Address
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Address Line | 314 ORAL CHURCH RD
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City | SUMRALL
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State | MS
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Zip | 39482-4021
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Country | US
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Telephone | 601-606-0558
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 904349
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License Number State | MS
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