MALLORY STEPHENS TATUM (P.A.) – Physician Assistant, NPI 1467978403
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MALLORY STEPHENS TATUM (P.A.)
401 Southcrest Cir Ste 201
Southaven, MS 386716721
Phone: (901) 226-0456
Type: Location
6029 Walnut Grove Rd Ste 305
Memphis, TN 381202155
Phone: (901) 226-0533
Type: Location
100 Baptist Memorial Cir Ste 200
Oxford, MS 386554476
Phone: (662) 513-3246
Type: Location
255 Baptist Blvd Ste 401
Columbus, MS 397052006
Phone: (662) 244-2288
Type: Location
7736 Airways Blvd
Southaven, MS 386715306
Phone: (662) 772-5222
Type: Location
2301 S LaMar Blvd Ste 140
Oxford, MS 386555373
Phone: (662) 513-3246
Type: Location
2550 Parr Ave
Dyersburg, TN 380242033
Phone: (731) 325-5678
Type: Location
7600 Wolf River Blvd
Ste 200
Germantown, TN 38138
Phone: (901) 747-1000
Fax: (901) 747-1001
Type: Location
9160 Highway 64 Ste 105
Lakeland, TN 380023011
Phone: (901) 213-0100
Type: Location
8016, Ellis Road, Bartlett, Shelby County, Tennessee, 38133, United States
BARTLETT, TN 381332806
Phone: (662) 322-9442
Type: Mailing
105, Lakeland Road, Mooresville, Iredell County, North Carolina, 28117, United States
LAKELAND, TN 380023011
Phone: (901) 213-0100
Fax: (901) 213-0101
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 6 Open Payments records for all available years, with a total value of $532.
Total Amount is formed as General ($532) + Research ($0) + Ownership ($0) = $532.
Last reported payment date: 2024-03-28 • Largest payer in this snapshot: ABBVIE INC. ($234).
Total Amount
$532
General + Research + Ownership
Payments
6
Total payment records
General Amount
$532
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-03-28
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $234 |
| Edwards Lifesciences Corporation | $149 |
| GENZYME CORPORATION | $97 |
| Neurocrine BioSciences Inc. | $52 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2017-09-28
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20170928002449 | I | Physician Assistant | TN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 38671)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | MS |
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