Organization
TUCKER INTERNAL MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA E DAVIDSON MD (OWNER)
(770) 366-1229
Entity
Organization
Contact information
Practice address
4228 FIRST AVE, STE 1, TUCKER, GA 30084-4426
(770) 414-5758
(770) 414-8699
Mailing address
PO BOX 506, TUCKER, GA 30085-0506
(770) 414-5758
(770) 414-8699
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
028960
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000335838K
—
GA
Enumeration date
06/30/2012
Last updated
06/30/2012
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