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Individual

TRACY PAVONE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
AA

Contact information

Practice address
3100 KEMBLE AVE, BRUNSWICK, GA 31520-4211
(912) 264-7000
Mailing address
PO BOX 235019, MONTGOMERY, AL 36123-5019
(334) 279-1450
(334) 279-1660

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
002697
GA
367H00000X
Anesthesiologist Assistant
Primary
2697
GA

Other

Enumeration date
01/29/2007
Last updated
04/13/2011
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