Provider Demographics
NPI:1871526624
Name:TUCKER, SUSANNE E (MS, LAT, ATC, ITAT)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:E
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MS, LAT, ATC, ITAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 PLEASANT HILL RD STE 130
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1407
Mailing Address - Country:US
Mailing Address - Phone:229-292-0877
Mailing Address - Fax:
Practice Address - Street 1:3855 PLEASANT HILL RD
Practice Address - Street 2:STE. 130
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1407
Practice Address - Country:US
Practice Address - Phone:229-292-0877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0010362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer