Active NPI
Sheridan G Tucker, M.D.
- Psychiatry Physician
- Meridian, MS
National Provider Identifier
1801971379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 16900
- Practice address
- 5000 Highway 39 N
Meridian, MS 39301 - Phone
- (601) 483-6211
- Fax
- (601) 482-3623
- NPI assigned
- Oct 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 16900 | MS | Primary |
| Child & Adolescent Psychiatry Physician | 2084P0804X | 16900 | MS |
Addresses
Primary practice location
5000 Highway 39 N
Meridian, MS 39301
Mailing address
5000 Highway 39 N
Meridian, MS 39301
Phone (601) 483-6211
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00122686 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16900 | MS | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422748800000",
"number": "1801971379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5000 HIGHWAY 39 N",
"city": "MERIDIAN",
"state": "MS",
"postal_code": "39301",
"telephone_number": "601-483-6211",
"fax_number": "601-482-3623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5000 HIGHWAY 39 N",
"city": "MERIDIAN",
"state": "MS",
"postal_code": "39301",
"telephone_number": "601-483-6211",
"fax_number": "601-482-3623"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUCKER",
"first_name": "SHERIDAN",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-25",
"last_updated": "2015-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MS",
"license": "16900",
"primary": true
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "MS",
"license": "16900",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00122686",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Meridian, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.