Healthcare Provider Details

I. General information

NPI: 1720107253
Provider Name (Legal Business Name): GAY W TUCKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E 3RD ST
CHATTANOOGA TN
37403-2102
US

IV. Provider business mailing address

1138 CONSTITUTION DR
CHATTANOOGA TN
37405-4244
US

V. Phone/Fax

Practice location:
  • Phone: 423-209-8030
  • Fax:
Mailing address:
  • Phone: 423-267-0430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number64837
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: