Individual
TATASHA TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ST
Contact information
Practice address
2614 NORTHGATE RD, ALBANY, GA 31721-1597
(229) 888-5485
Mailing address
2614 NORTHGATE RD, ALBANY, GA 31721-1597
(229) 888-5485
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
GA
Other
Enumeration date
09/20/2017
Last updated
09/20/2017
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