Provider Demographics
NPI:1649230335
Name:TUCK, STUART M (DPM)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:M
Last Name:TUCK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1350 UPPER HEMBREE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-0929
Mailing Address - Country:US
Mailing Address - Phone:678-426-2171
Mailing Address - Fax:404-446-1957
Practice Address - Street 1:5445 MERIDIAN MARK RD STE 390
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4755
Practice Address - Country:US
Practice Address - Phone:404-237-3668
Practice Address - Fax:770-939-7393
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000590213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3753794OtherAETNA
GA00400144AMedicaid
GAP00225317OtherRAILROAD MEDICARE
GA1289698OtherUNITED HEALTHCARE
GA289002OtherWELLCARE MEDICARE
GAT89059Medicare UPIN
GA00400144AMedicaid
GA1103400015Medicare NSC
GA48SCCRFMedicare PIN