Wilson Larry Tucker, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

031142 Issued in GA

Practice address

304 Shorter Ave NW
Rome, GA 30165-4290

Phone

(706) 291-3700

Fax

(706) 291-8712

NPI assigned

Jul 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399507200000",
    "number": "1629090964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 E 2ND AVE",
            "address_2": "SUITE 103",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301613224",
            "telephone_number": "706-509-3000",
            "fax_number": "706-509-4608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 SHORTER AVE NW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301654290",
            "telephone_number": "706-291-3700",
            "fax_number": "706-291-8712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "WILSON",
        "middle_name": "LARRY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2014-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "031142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00375229S",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tucker Chiropractic-Rome
• Cory R Tucker, PT
• Kelsee Tucker, LCSW
• Leslie A Tucker, DC
• Victor Jason Tucker, PA-C
• Sonia Elizabeth Turner, FNP-BC
• Judith Tutin, PH.D.
• Kaleigh Marie Tutorow, M.ED., CCC-SLP
• Brian Tye, SPEECH THERAPIST
• Chesnee Tyler, NP

• Family Medicine Physician in Rome, GA
• Providers in Rome, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.