Individual
JUSTIN B TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6799 GREAT OAKS RD STE 100, MEMPHIS, TN 38138-2571
(901) 751-0405
(901) 751-9694
Mailing address
6799 GREAT OAKS RD STE 100, MEMPHIS, TN 38138-2571
(901) 751-0405
(901) 751-9694
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2280
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q000691
—
TN
Enumeration date
12/06/2012
Last updated
10/25/2017
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