Provider Demographics
NPI:1174772693
Name:TATUM, COMEKA
Entity type:Individual
Prefix:
First Name:COMEKA
Middle Name:
Last Name:TATUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BOXWOOD BLVD
Mailing Address - Street 2:# 3114
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-2327
Mailing Address - Country:US
Mailing Address - Phone:706-939-4556
Mailing Address - Fax:
Practice Address - Street 1:421 12TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2522
Practice Address - Country:US
Practice Address - Phone:706-494-7776
Practice Address - Fax:706-494-7076
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker