Provider Demographics
NPI:1881824639
Name:TUCKER, THOMAS LEON (RN, GNP-BC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LEON
Last Name:TUCKER
Suffix:
Gender:M
Credentials:RN, GNP-BC
Other - Prefix:MR
Other - First Name:THOMAS
Other - Middle Name:LEON
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, GNP-BC
Mailing Address - Street 1:2768 ROYAL BLF
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-5301
Mailing Address - Country:US
Mailing Address - Phone:404-534-1398
Mailing Address - Fax:
Practice Address - Street 1:2768 ROYAL BLF
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-5301
Practice Address - Country:US
Practice Address - Phone:404-534-1398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN177247163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology