Individual
MS. TRACY L. ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
101 RIVERSTONE VIS, SUITE 111, BLUE RIDGE, GA 30513-6648
(706) 946-4200
(706) 946-4243
Mailing address
101 RIVERSTONE VIS, SUITE 111, BLUE RIDGE, GA 30513-6648
(706) 946-4200
(706) 946-4243
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA-440
ME
363AM0700X
Medical Physician Assistant
Primary
005894
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003100897C
—
GA
Enumeration date
08/03/2006
Last updated
06/21/2014
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