Provider Demographics
NPI:1487720504
Name:ROBERT P TUCKER III, M.D. P.C.
Entity type:Organization
Organization Name:ROBERT P TUCKER III, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-813-0026
Mailing Address - Street 1:9875 MEDLOCK BRIDGE PKWY
Mailing Address - Street 2:#100
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6630
Mailing Address - Country:US
Mailing Address - Phone:770-813-0026
Mailing Address - Fax:770-813-0029
Practice Address - Street 1:9875 MEDLOCK BRIDGE PKWY
Practice Address - Street 2:#100
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-6630
Practice Address - Country:US
Practice Address - Phone:770-813-0026
Practice Address - Fax:770-813-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00319514-BMedicaid
GA00319514-BMedicaid