Provider Demographics
NPI:1174576730
Name:STRETCH, TOMMIE BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:TOMMIE
Middle Name:BRIAN
Last Name:STRETCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SGT PRENTISS DR
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4740
Mailing Address - Country:US
Mailing Address - Phone:601-445-9543
Mailing Address - Fax:601-445-9803
Practice Address - Street 1:55 SERGEANT PRENTISS DR
Practice Address - Street 2:SUITE 7
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4782
Practice Address - Country:US
Practice Address - Phone:601-445-9543
Practice Address - Fax:601-445-9803
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12805208000000X
LA019243208000000X
VA0101283243208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00113941Medicaid
LA1928291Medicaid