Provider Demographics
NPI:1922052620
Name:TUCKER, BARBARA ELLEN (RD, LD, MED)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ELLEN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RD, LD, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 ABBEY CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6017
Mailing Address - Country:US
Mailing Address - Phone:707-416-1021
Mailing Address - Fax:678-402-5619
Practice Address - Street 1:1000 JOHNSON FERRY RD
Practice Address - Street 2:BLDG F SUITE 120
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2114
Practice Address - Country:US
Practice Address - Phone:707-416-1021
Practice Address - Fax:678-402-5619
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA849067133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered