| Ricky O Tatum, PAC | |
|
306 Isabella St, Waycross, GA 31501-3636 | |
| (912) 285-9990 | |
| (912) 338-8931 |
| Full Name | Ricky O Tatum |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Experience | 47 Years |
| Location | 306 Isabella St, Waycross, Georgia |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073837555 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 002235 (Georgia) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Ware Express Care, Llc | 1658639075 | 3 |
| Entity Name | Ware Express Care, LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1679083539 PECOS PAC ID: 1658639075 Enrollment ID: O20171212002925 |
| Mailing Address | Practice Location Address |
|---|---|
| Ricky O Tatum, PAC 1007 Mary St, Waycross, GA 31503-3823 Ph: (912) 449-8601 | Ricky O Tatum, PAC 306 Isabella St, Waycross, GA 31501-3636 Ph: (912) 285-9990 |
Tayler Hutto Allen, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2100 Riverside Ave, Waycross, GA 31501 Phone: 912-490-7777 Fax: 912-490-7779 |
Josselynn Elizabeth Mallard, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1706 Alice St, Waycross, GA 31501 Phone: 912-285-1140 Fax: 912-285-1125 |
Kimberly Cecil, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1218 Alice St, Waycross, GA 31501 Phone: 912-590-0973 Fax: 912-590-0180 |
Carly Zoe Swett, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 1900 Tebeau St, Waycross, GA 31501 Phone: 760-937-1852 |
Laken Renee Tanner, MSPAP, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 1900 Tebeau St, Waycross, GA 31501 Phone: 912-283-3030 |
Cullee Peavey Richardson, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 711 Knight Ave, Waycross, GA 31501 Phone: 912-283-9423 Fax: 912-283-2946 |
David A Rios, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 808 Beacon St, Waycross, GA 31501 Phone: 912-490-4325 Fax: 912-490-7673 |