Provider Demographics
NPI:1124431531
Name:PERDUE, BETH TUCKER (RN, CDE)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:TUCKER
Last Name:PERDUE
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:BETH
Other - Last Name:TUCKER PERDUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, CDE
Mailing Address - Street 1:4750 WATERS AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6267
Mailing Address - Country:US
Mailing Address - Phone:912-350-6543
Mailing Address - Fax:912-350-7690
Practice Address - Street 1:4750 WATERS AVE STE 108
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404
Practice Address - Country:US
Practice Address - Phone:912-350-6543
Practice Address - Fax:912-350-7690
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN089977163W00000X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003147133AMedicaid
GAP01333776OtherRAILROAD MEDICARE
GA003147133AMedicaid