Individual
TRACIA A A WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3327 WAGGONER LN, REX, GA 30273-5220
(678) 353-7916
Mailing address
3327 WAGGONER LN, REX, GA 30273-5220
(678) 353-7916
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
25064627
GA
Other
Enumeration date
09/10/2025
Last updated
09/10/2025
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