Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 020492 | GA |
NPI | 1144219239 |
---|---|
Provider Name | Dr. John Tucker |
First Address | Marietta, GA 30060-7282 |
Second Address | Marietta, GA 30060-7282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 08/07/2007 |