Provider Demographics
NPI:1316025307
Name:TUCK, R STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:R STEVEN
Middle Name:
Last Name:TUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26040
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31221-6040
Mailing Address - Country:US
Mailing Address - Phone:478-475-1299
Mailing Address - Fax:478-405-7928
Practice Address - Street 1:777 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2102
Practice Address - Country:US
Practice Address - Phone:478-633-7550
Practice Address - Fax:478-633-3235
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033217207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00429514EMedicaid
GA52048753OtherBCBS OF GA
GA000429514HMedicaid
GA11BDNSJMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
GA00429514EMedicaid
GAE57740Medicare UPIN
GA000429514HMedicaid