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1053669119
JACKSON SETH TUCKER
THOMASVILLE, GA
NPI
1053669119
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
367H00000X Anesthesiologist Assistant
(Licence: GA 00123)
Enumeration Date
2012-08-21
Last Update Date
2012-08-21
Business Address
-- JACKSON SETH TUCKER AA
915 GORDON AVE
THOMASVILLE, GA 31792-6614
Phone number: 800-232-5703
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Mailing Address
-- JACKSON SETH TUCKER AA
PO BOX 2125
COLUMBUS, GA 31902-2125
Phone number: 800-232-5703
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