Provider Demographics
NPI:1912615220
Name:TUCKER, GEORGE SAMUEL JR
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:SAMUEL
Last Name:TUCKER
Suffix:JR
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 1:1134 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-3328
Mailing Address - Country:US
Mailing Address - Phone:419-934-3918
Mailing Address - Fax:
Practice Address - Street 1:1134 SOUTH ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-3328
Practice Address - Country:US
Practice Address - Phone:419-934-3918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant