Individual
TRACY R RAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1305 JENNINGS MILL RD STE 110, WATKINSVILLE, GA 30677-7241
(706) 613-5880
Mailing address
2727 PACES FERRY RD SE STE 1-1100, ATLANTA, GA 30339-6151
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
18564
AL
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
48075
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051559050
—
AL
01
—
51006180
BCBS
—
01
—
51521091
BCBS
AL
Enumeration date
03/01/2006
Last updated
12/06/2019
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