Crockett, Tracy

Crockett, Tracy is an individual health care provider with primary practice located at 2470 Daniels Bridge Rd Bldg 200 Suite 251, Athens GA 30606-6187. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Crockett, Tracy can be contacted via phone (706) 389-3440.

Contact Information

Primary practice address
2470 Daniels Bridge Rd Bldg 200 Suite 251 Athens GA 30606-6187
Fax: (706) 353-2771
Website:

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 1763 Georgia

Profile Details

NPI number 1184626996
LBN Legal business name Crockett, Tracy
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 11th, 2005
Last updated Feb 20th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184626996 NPPES
Georgia MEDICAID 100000351C

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