Provider Demographics
NPI:1396849006
Name:TUCKER, EVELYN R (MD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:R
Last Name:TUCKER
Suffix:
Gender:F
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 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:565 COLUMBIA AVE
Practice Address - Street 2:STE 100
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036
Practice Address - Country:US
Practice Address - Phone:803-936-7476
Practice Address - Fax:803-936-7477
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20534207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC205343Medicaid
SCH356546325Medicare PIN