Provider Demographics
NPI:1033924089
Name:TATUM, JAMIER M
Entity type:Individual
Prefix:
First Name:JAMIER
Middle Name:M
Last Name:TATUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9809 WILD PRAIRIE WAY
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-4277
Mailing Address - Country:US
Mailing Address - Phone:817-240-3153
Mailing Address - Fax:
Practice Address - Street 1:9809 WILD PRAIRIE WAY
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4277
Practice Address - Country:US
Practice Address - Phone:817-240-3153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator