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Individual

DR. TRACY ELIZABETH WIMBUSH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1240 EAGLES LANDING PKWY, SUITE 300, STOCKBRIDGE, GA 30281
(770) 506-4350
(770) 506-9860
Mailing address
900 CIRCLE 75 PKWY SE, SUITE 1700, ATLANTA, GA 30339-3035
(770) 953-6929
(770) 953-6972

Taxonomy

Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
MD433123
PA
207P00000X
Emergency Medicine Physician
213411
MA
207P00000X
Emergency Medicine Physician
243910
NY
207P00000X
Emergency Medicine Physician
MD433123
PA
208VP0000X
Pain Medicine Physician
Primary
068869
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003134595J
GA
05
003134595K
GA
05
003134595L
GA
05
2034247
MA
01
468709
TUFTS HEALTH PLAN
MA
01
J27108
BCBS MA
MA
Enumeration date
12/13/2005
Last updated
06/03/2014
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