Individual
MRS. TRACY ANNETTE MADISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
485 MCLIN CIR, FLORENCE, MS 39073-7939
(601) 845-5827
Mailing address
485 MCLIN CIR, FLORENCE, MS 39073-7939
(601) 845-5827
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
00770423
MS
171M00000X
Case Manager/Care Coordinator
00770594
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770423
—
MS
05
—
00770594
—
MS
Enumeration date
01/09/2012
Last updated
01/09/2012
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