Provider Demographics
NPI:1962194530
Name:MABILE, TATUM MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:TATUM
Middle Name:MARIE
Last Name:MABILE
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5248 OCEAN BREEZE CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1361
Mailing Address - Country:US
Mailing Address - Phone:619-952-2985
Mailing Address - Fax:
Practice Address - Street 1:300 NEW RIVER PKWY STE 37
Practice Address - Street 2:
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-4545
Practice Address - Country:US
Practice Address - Phone:843-208-2420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant