Provider Demographics
NPI:1275840068
Name:TUCKER FAMILY PRACTICE, L.L.C.
Entity Type:Organization
Organization Name:TUCKER FAMILY PRACTICE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FEROZ ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:LALANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-771-8677
Mailing Address - Street 1:1462 MONTREAL RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6929
Mailing Address - Country:US
Mailing Address - Phone:770-938-5552
Mailing Address - Fax:
Practice Address - Street 1:1462 MONTREAL RD
Practice Address - Street 2:SUITE 307
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6929
Practice Address - Country:US
Practice Address - Phone:770-938-5552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty