Provider Demographics
NPI:1144219239
Name:TUCKER, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:TUCKER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:790 CHURCH ST NE
Mailing Address - Street 2:SUITE 570
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7282
Mailing Address - Country:US
Mailing Address - Phone:770-428-0462
Mailing Address - Fax:770-427-8001
Practice Address - Street 1:790 CHURCH ST NE
Practice Address - Street 2:SUITE 570
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7282
Practice Address - Country:US
Practice Address - Phone:770-428-0462
Practice Address - Fax:770-427-8001
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0204922086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery