# LAUREL FORK FAMILY PRACTICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336639657
- **Authorized official:** DR. JOHN WILLIAM TRACY MD (OWNER)
- **Authorized official phone:** (276) 398-2532

## Contact information

- **Practice address:** 1205 STONE MOUNTAIN ROAD, LAUREL FORK, VA 24352
- **Practice address phone:** (276) 398-2532
- **Practice address fax:** (276) 398-2534
- **Mailing address:** PO BOX 85, LAUREL FORK, VA 24352-0085
- **Mailing address phone:** (276) 398-2532
- **Mailing address fax:** (276) 398-2534

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 0101236128 | VA | Yes |

## Other

- **Enumeration date:** 05/11/2018
- **Last updated:** 05/11/2018