Individual
TRACEY BASTIAANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4 LIVE OAK CT, MOULTRIE, GA 31768-6783
(229) 785-2400
Mailing address
PO BOX 2876, MOULTRIE, GA 31776-2876
(229) 785-2400
(229) 502-9793
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
OT018067
PA
Other
Enumeration date
06/05/2013
Last updated
09/04/2025
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