Tucker Internal Medicine, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

028960 Issued in GA

Legal business name

TUCKER INTERNAL MEDICINE, LLC

Practice address

4228 First Ave
Ste 1
Tucker, GA 30084-4426

Phone

(770) 414-5758

Fax

(770) 414-8699

NPI assigned

Jun 30, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Laura E Davidson, MD

Title

Owner

Phone

(770) 366-1229

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341014400000",
    "number": "1386908739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 506",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300850506",
            "telephone_number": "770-414-5758",
            "fax_number": "770-414-8699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4228 FIRST AVE",
            "address_2": "STE 1",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844426",
            "telephone_number": "770-414-5758",
            "fax_number": "770-414-8699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TUCKER INTERNAL MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-30",
        "last_updated": "2012-06-30",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-366-1229",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "028960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000335838K",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hamrawit Tsegaye, CMT
• Tucker Chiropractic
• Tucker Chiropractic Associates Incorporated
• Tucker Family Practice, L.L.C.
• Tucker Health Care LLC (Meadowbrook Health Care Center)
• Tucker Investments & Associates LLC (Grace Healthcare of Tucker)
• Tucker Medical Center P.C.
• Tucker Neck and Back, LLC
• Tucker Operating Company LLC
• Tucker Operating Group LLC

• Primary Care Clinic/Center in Tucker, GA
• Providers in Tucker, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.