Healthcare Provider Details

I. General information

NPI: 1629631072
Provider Name (Legal Business Name): TUCKER LEE BETTIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5356 REYNOLDS ST STE 510
SAVANNAH GA
31405-6017
US

IV. Provider business mailing address

836 E 65TH ST STE 22
SAVANNAH GA
31405-4493
US

V. Phone/Fax

Practice location:
  • Phone: 912-819-2622
  • Fax: 912-819-3320
Mailing address:
  • Phone: 912-819-2622
  • Fax: 912-819-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number100226
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: