Individual
HENRY GRADY TUCKER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
11 SYCAMORE SQ, DECATUR, GA 30030-1952
(404) 247-1215
Mailing address
11 SYCAMORE SQ, DECATUR, GA 30030-1952
(404) 247-1215
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT006121
GA
Other
Enumeration date
11/04/2015
Last updated
11/04/2015
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