Healthcare Provider Details

I. General information

NPI: 1700721370
Provider Name (Legal Business Name): JOHN ROBERT TUCKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CARTER PARK DR STE B
SENECA SC
29678-1152
US

IV. Provider business mailing address

300 E MCBEE AVE STE 300
GREENVILLE SC
29601-2899
US

V. Phone/Fax

Practice location:
  • Phone: 864-482-3122
  • Fax: 864-482-3152
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number8059
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: