Individual
CONNIE TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2738 WHITES MILL RD, DECATUR, GA 30034-2658
(404) 781-8224
Mailing address
2738 WHITES MILL RD, DECATUR, GA 30034-2658
(404) 781-8224
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
257605937A
—
GA
Enumeration date
03/09/2018
Last updated
03/09/2018
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