Tucker, Justin B

Tucker, Justin B is an individual health care provider with primary practice located at 6799 Great Oaks Rd Ste 100 , Memphis TN 38138-2571. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Tucker, Justin B can be contacted via phone (901) 751-0405.

Contact Information

Primary practice address
6799 Great Oaks Rd Ste 100 Memphis TN 38138-2571
Phone: (901) 751-0405
Fax: (901) 751-9694
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 2280 Tennessee

Profile Details

NPI number 1669717328
LBN Legal business name Tucker, Justin B
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 6th, 2012
Last updated Oct 25th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669717328 NPPES
Tennessee MEDICAID Q000691

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