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General NPI Number Information
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NPI Number | 1396766259
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Entity Type | Organization
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Legal Business Name | GRIFFIN UROLOGY, PC
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 07/19/2007
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Provider Practice Location Address
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Address Line | 653 S 8TH ST
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City | GRIFFIN
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State | GA
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Zip | 30224-4242
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Country | US
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Telephone | 770-227-1075
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Fax | 770-227-1085
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Provider Business Mailing Address
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Address Line | 653 S 8TH ST
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City | GRIFFIN
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State | GA
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Zip | 30224-4242
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Country | US
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Telephone | 770-227-1075
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Fax | 770-227-1085
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. LUCIAN L TATUM JR.
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Credential | MD
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Telephone | 770-227-1075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 009748
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License Number State | GA
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