Provider Demographics
NPI:1316195803
Name:GEORGE TUCKER MD PC
Entity Type:Organization
Organization Name:GEORGE TUCKER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-763-3250
Mailing Address - Street 1:505 FAIRBURN ROAD SUITE 206
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2018
Mailing Address - Country:US
Mailing Address - Phone:404-763-3250
Mailing Address - Fax:404-699-2433
Practice Address - Street 1:505 FAIRBURN ROAD SUITE 206
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2018
Practice Address - Country:US
Practice Address - Phone:404-763-3250
Practice Address - Fax:404-699-2431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA22068207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000206533GMedicaid
GA16BBCXWMedicare PIN
GAD91033Medicare UPIN