Provider Demographics
NPI:1023342730
Name:TATUM, PAIGE ELIZABETH (PTA)
Entity type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:ELIZABETH
Last Name:TATUM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-1026
Mailing Address - Country:US
Mailing Address - Phone:706-219-4054
Mailing Address - Fax:
Practice Address - Street 1:185 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-1026
Practice Address - Country:US
Practice Address - Phone:706-219-4054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA001527225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant