Healthcare Provider Details

I. General information

NPI: 1154596120
Provider Name (Legal Business Name): DONALD TUCKER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WILLIAM NORTHERN BLVD
TULLAHOMA TN
37388-4754
US

IV. Provider business mailing address

100 WILLIAM NORTHERN BLVD
TULLAHOMA TN
37388
US

V. Phone/Fax

Practice location:
  • Phone: 931-454-0489
  • Fax: 931-454-2348
Mailing address:
  • Phone: 931-454-0489
  • Fax: 931-454-2348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD024197
License Number StateTN

VIII. Authorized Official

Name: DONALD V TUCKER JR.
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 931-454-0489