MR. CHARLES THOMAS TUCKER (NPI# 1831204478) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831204478 |
| Entity Type | Individual |
| Full Name | MR. CHARLES THOMAS TUCKER |
| Credential | MD |
| Practice Address |
111 Colonial Way Ste 2 Jesup GA 31545-0132 |
| Mailing Address |
208 Scranton Connector Suite 117 Brunswick GA 31525-0559 |
| Practice Telephone | 9125881919 |
| Practice Fax Number | 9125881919 |
| Mailing Telephone | 9122645961 |
| Mailing Fax Number | 9122629499 |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2020-01-16 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
026402 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | WELLCARE | N363398 | 01 |
| GA | 000291079A | 05 | |
| GA | AMERIGROUP | 01035667 | 01 |
| GA | RAILROAD MEDICARE | 390004393 | 01 |
| GA | BLUE SHIELD | 616370 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 208 Scranton Connector, Suite 117, Brunswick, GA 315250559 | 9122645961 | 9122629499 |
| 3025 Shrine Rd Ste 450, Brunswick, GA 315204787 | 9122646133 | 9122671415 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497039135 | Charles Lee Tucker I | Counselor | 12925 Ne 59th St, Spencer, OK 73084-8605 | 2011-09-29 |
| 1285848887 | Charles Morton Tucker | Psychologist | 900 Summit La, Oreland, PA 19075-2526 | 2007-05-10 |
| 1124055322 | Charles Thomas Tucker | Chiropractor | 2516 Nw 43rd St, Gainesville, FL 32606-7491 | 2006-06-26 |
| 1639173396 | Charles L Tucker | Family Medicine | 195 Hospital Dr, Cherokee Village, AR 72529-7314 | 2005-06-10 |
| 1902405392 | Charles Thomas Tucker IIi | Chiropractor | 3014 Wade Hampton Blvd, Taylors, SC 29687-2716 | 2020-10-19 |
| 1043853278 | Charles Mahlon Tucker | Physical Therapy Assistant | 112 W Citrus St, Altamonte Springs, FL 32714-2502 | 2019-10-21 |
| 1023662921 | Charles Tucker | Pharmacist | 200 S Rachal St, Sinton, TX 78387-2524 | 2019-07-29 |
| 1497255244 | Charles Edward Tucker | Counselor | 3088 Cranberry Hwy Ste A, East Wareham, MA 02538-4800 | 2018-02-19 |
| 1295893030 | Charles Douglas Tucker | Surgery | 300 S 8th St, Suite 205 E, Murray, KY 42071-2400 | 2006-12-05 |
| 1669567756 | Charles R. Tucker | Dentist | 515 College Ave, Alva, OK 73717-2202 | 2006-10-04 |
| Street Address |
111 COLONIAL WAY STE 2 |
| City | JESUP |
| State | GA |
| Zip Code | 31545-0132 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730663857 | Nephrology and Hypertension Medical Associates PC | Specialist | 111 Colonial Way Ste 2, Jesup, GA 31545-0132 | 2018-09-25 |
| 1811042815 | Wynne Kendra Lott | Physician Assistant | 111 Colonial Way Ste 2, Jesup, GA 31545 | 2007-01-23 |
| 1437229309 | Nephrology & Hypertension Medical Associates, PC | Internal Medicine | 111 Colonial Way Ste 2, Jesup, GA 31545-0132 | 2006-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154922441 | Southern Pharmacy Group LLC | Pharmacy | 110 Allison St., Jesup, GA 31545 | 2020-11-04 |
| 1093350118 | Joseph Hires | Physical Therapist | 1064 N Macon St, Jesup, GA 31545 | 2019-11-13 |
| 1952866279 | Scott's Transportation of Georgia, LLC | Non-emergency Medical Transport (VAN) | 3670 Waycross Hwy, Jesup, GA 31545 | 2019-02-01 |
| 1386035335 | Shane's Crib | Substance Abuse Rehabilitation Facility | 1303 South 1st Street, Jesup, GA 31545 | 2015-02-12 |
| 1770839607 | Sandra L. Mager, M.d.p.c. | Obstetrics & Gynecology | 114 W. Cherry Street, Jesup, GA 31545 | 2012-07-30 |
| 1427318617 | Crandall Eye Physicians and Surgeons LLC | Ophthalmology | 136 W. Cherry St., Jesup, GA 31545 | 2012-05-21 |
| 1356615934 | Andrea Brooke Meeks | Assistant Behavior Analyst | 1316 W Orange St, Jesup, GA 31545 | 2012-02-29 |
| 1932419736 | Wilma R Cote | Nurse Practitioner | 391 South First St., Jesup, GA 31545 | 2010-10-14 |
| 1205144425 | Air Evac Ems Inc | Ambulance | 148 Peach Tree Street, Jesup, GA 31545 | 2010-09-22 |
| 1881911451 | Surgery Center of Bji, LLC | Clinic/Center | 112 Professional Court, Jesup, GA 31545 | 2010-04-22 |
| Find all providers in zip 31545 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437229309 | Nephrology & Hypertension Medical Associates, PC | Internal Medicine | 111 Colonial Way Ste 2, Jesup, GA 31545-0132 | 2006-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053968511 | Gwinnett Nephrology LLC | Internal Medicine | 1567 Janmar Rd Ste 100, Snellville, GA 30078-0308 | 2019-08-20 |
| 1063070654 | Kidney Specialists of Georgia PC | Internal Medicine | 575 Professional Dr Ste 290, Lawrenceville, GA 30046-3347 | 2019-05-30 |
| 1295219103 | Renal Associates of Lagrange LLC | Internal Medicine | 1300 Lafayette Pkwy Ste D, Lagrange, GA 30241-2610 | 2018-09-18 |
| 1912484395 | Atlanta Kidney Care LLC | Internal Medicine | 1462 Montreal Rd Ste 214, Tucker, GA 30084-6931 | 2018-07-27 |
| 1932591948 | Georgia Renal and Hypertension Care Inc | Internal Medicine | 928 S Park St, Suite H, Carrollton, GA 30117-4501 | 2015-02-27 |
| 1316344492 | Oconee Nephrology Associates, Inc. | Internal Medicine | 700 Oglethorpe Ave., Suite B1, Athens, GA 30606 | 2014-12-04 |
| 1134524853 | Sheryl Cababat Caberto | Internal Medicine | 1648 Pierce Dr Ne, Atlanta, GA 30307 | 2014-10-23 |
| 1306265384 | Srikar Kumar | Internal Medicine | 250 Village Center Pkwy Ste 100, Stockbridge, GA 30281-9104 | 2014-04-07 |
| 1477995868 | Moti Samaki | Internal Medicine | 1500 Oglethorpe Ave Ste 500c, Athens, GA 30606-2184 | 2013-07-25 |
| 1902143233 | Barry Jay Rosenbaum | Internal Medicine | 2000 Castleway Dr Ne, Atlanta, GA 30345-3914 | 2013-01-07 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.