Individual
TRACEY S THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4221 ASHEVILLE HWY, KNOXVILLE, TN 37914-3508
(865) 392-7264
Mailing address
PO BOX 746725, ATLANTA, GA 30374-6725
(312) 733-9730
(773) 866-8014
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
02969
KY
207Q00000X
Family Medicine Physician
2012-02056
NC
207Q00000X
Family Medicine Physician
2438
WV
207Q00000X
Family Medicine Physician
34.009991
OH
207Q00000X
Family Medicine Physician
Primary
5634
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000484080
ANTHEM BCBS
KY
01
—
00799629
RR MEDICARE
WV
05
—
2754318
—
OH
05
—
3810016933
—
WV
05
—
64124860
—
KY
Enumeration date
06/16/2006
Last updated
10/31/2024
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