Organization
TRACYS MEDICINE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNAN LYNN TRACY (PHARMACIST IN CHARGE)
(770) 939-1642
Entity
Organization
Contact information
Practice address
3171 TUCKER NORCROSS RD, TUCKER, GA 30084-2124
(770) 939-1642
(770) 723-9515
Mailing address
3171 TUCKER NORCROSS RD, TUCKER, GA 30084-2124
(770) 939-1642
(770) 723-9515
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
PHRE005288
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000422881B
—
GA
Enumeration date
09/29/2005
Last updated
04/25/2018
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