Individual
MRS. TRACY LYNN VERCILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
229 S DAVIS RD STE 900, LAGRANGE, GA 30241-2609
(706) 756-1489
Mailing address
1140 PYNE RD, LAGRANGE, GA 30240-6624
(205) 913-6567
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
RN085566
GA
Other
Enumeration date
03/07/2019
Last updated
03/07/2019
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