Healthcare Provider Details

I. General information

NPI: 1467131425
Provider Name (Legal Business Name): GAIL TUCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GAIL TUCKER

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 NAVAJO TRL
COVINGTON GA
30016-6917
US

IV. Provider business mailing address

745 NAVAJO TRL
COVINGTON GA
30016-6917
US

V. Phone/Fax

Practice location:
  • Phone: 408-837-0116
  • Fax:
Mailing address:
  • Phone: 770-899-2646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCN0000029172
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: