Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 03609 | GA |
Y | 111NI0900X | Internist | 03609 | GA |
N | 207RH0002X | Hospice and Palliative Medicine | 03609 | GA |
NPI | 1285607648 |
---|---|
Provider Name | Dr. Sharon Tuckett |
First Address | Carrollton, GA 30117-3857 |
Second Address | Villa Rica, GA 30180 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 13/02/2019 |