Provider Demographics
NPI:1427516780
Name:TUCHMANN, JAKE ANTHONY
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:ANTHONY
Last Name:TUCHMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3892 GREENSWARD VW NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5780
Mailing Address - Country:US
Mailing Address - Phone:770-313-6772
Mailing Address - Fax:
Practice Address - Street 1:3892 GREENSWARD VW NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5780
Practice Address - Country:US
Practice Address - Phone:770-313-6772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer