Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Johnathon Antonio Montrel Tucker, PA

Individual provider Psychiatry Physician · NPI 1912767674

Johnathon Antonio Montrel Tucker, PA is a Physician Assistant in Charleston, South Carolina. Graduated from Medical University of South Carolina College of Medicine in 2022, 4 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in South Carolina.

Years since qualifying
4
Trained at
Medical University of South Carolina College of Medicine
Licensed in
SC
In the registry since
2024
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

4 Carriage Ln Ste 200
Charleston, SC 29407-6049
Phone: (843) 266-7573
Fax: (843) 266-7578
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5259 (SC)
Psychiatry Physician Taxonomy 2084P0800X · Licence 5259 (SC)

Record details

NPI number1912767674
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorYes
NPI enumeratedMarch 20, 2024
Last updated in NPPESMarch 20, 2024
Certification dateMarch 20, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolMEDICAL UNIVERSITY OF SOUTH CAROLINA COLLEGE OF MEDICINE
Graduated 2022 (4 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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