=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265670988
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERICKA ILENE TUCKER M.S.CCC-A
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2009
-----------------------------------------------------
Last Update Date | 01/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2365 OLD MILTON PKWY SUITE 200
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30009-2140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-825-2469
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2365 OLD MILTON PKWY SUITE 200
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30009-2140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-825-2469
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 2537
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------