Individual
TRACY CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
2470 DANIELS BRIDGE RD, BLDG 200 SUITE 251, ATHENS, GA 30606-6187
(706) 389-3440
(706) 353-2771
Mailing address
1131 GOLF COURSE LN, ATHENS, GA 30605-5350
(706) 613-1518
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1763
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100000351C
—
GA
Enumeration date
08/11/2005
Last updated
02/20/2013
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