Individual
SLAVKO KUKUCKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
119 CHIMNEY RD, RINCON, GA 31326
(912) 826-0229
(912) 826-0449
Mailing address
119 CHIMNEY RD, RINCON, GA 31326
(912) 826-0229
(912) 826-0449
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
046877
GA
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000843235F
—
GA
01
—
52782040-008
BCBS GA FOR SAVANNAH LOCATION
GA
01
—
52782040-009
BCBS/GA FOR POOLER LOCATION
GA
01
—
582203199-004
TRICARE ID
GA
01
—
582203199-009
TRICARE ID
GA
01
—
CG4057
RR MEDICARE GROUP ID
GA
05
—
G46877
—
SC
01
—
GRP2837
MEDICARE GROUP ID
GA
01
—
P00441748
RR MEDICARE
GA
Enumeration date
02/22/2006
Last updated
08/14/2024
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