Individual
TRACY MARSHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
255 GRIMES RD, WOODSTOCK, GA 30188-6725
(678) 366-6050
(678) 366-6051
Mailing address
255 GRIMES RD, WOODSTOCK, GA 30188-6725
(678) 366-6050
(678) 366-6051
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
320900000X
GA
Other
Enumeration date
12/25/2015
Last updated
12/25/2015
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