Healthcare Provider Details

I. General information

NPI: 1194501742
Provider Name (Legal Business Name): MAGGIE C TUCKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GENTILLY BLVD STE 1300
CARTERSVILLE GA
30120-8504
US

IV. Provider business mailing address

42 FALCON CV
DALLAS GA
30132-6622
US

V. Phone/Fax

Practice location:
  • Phone: 470-490-6860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN-NP299681
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN299681
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: