Provider Demographics
NPI:1639358179
Name:ANDREW TUCKER
Entity Type:Organization
Organization Name:ANDREW TUCKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEEBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-354-2634
Mailing Address - Street 1:5354 REYNOLDS ST
Mailing Address - Street 2:SUITE 315
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6007
Mailing Address - Country:US
Mailing Address - Phone:912-354-2634
Mailing Address - Fax:912-354-8375
Practice Address - Street 1:5354 REYNOLDS ST
Practice Address - Street 2:SUITE 315
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-354-2634
Practice Address - Fax:912-354-8375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA55706207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7055Medicare PIN