Provider Demographics
NPI:1508672940
Name:TUCKER, GARRETT SCOTT
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:SCOTT
Last Name:TUCKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 US HIGHWAY 82 W STE 3&4
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-8200
Mailing Address - Country:US
Mailing Address - Phone:229-445-3509
Mailing Address - Fax:229-445-3513
Practice Address - Street 1:1909 US HIGHWAY 82 W STE 3&4
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31793-8200
Practice Address - Country:US
Practice Address - Phone:229-445-3509
Practice Address - Fax:229-445-3513
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN292159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily