Individual
TRACIE CHISLOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1002 W SOLOMON ST, GRIFFIN, GA 30223-2632
(678) 557-2613
Mailing address
1002 W SOLOMON ST, GRIFFIN, GA 30223-2632
(678) 557-2613
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Enumeration date
03/08/2019
Last updated
03/08/2019
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