Individual
JOHNATHON ANTONIO MONTREL TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4 CARRIAGE LN STE 200, CHARLESTON, SC 29407-6049
(843) 266-7573
(843) 266-7578
Mailing address
4 CARRIAGE LN STE 200, CHARLESTON, SC 29407-6049
(843) 266-7573
(843) 266-7578
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
5259
SC
363A00000X
Physician Assistant
Primary
5259
SC
Other
Enumeration date
03/20/2024
Last updated
03/20/2024
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