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General NPI Number Information
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NPI Number | 1205626249
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Entity Type | Individual
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Provider Name | JONAE TUCKER
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Gender |
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 2451B US HIGHWAY 17
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City | RICHMOND HILL
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State | GA
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Zip | 31324-3397
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Country | US
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Telephone | 615-560-6622
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Fax |
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Provider Business Mailing Address
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Address Line | 363 OWENS ST NE
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City | LUDOWICI
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State | GA
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Zip | 31316-0048
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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