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
Phone: (706) 389-3440
Fax: (706) 353-2771
Website:
Health care specialties
| Specialty | Code | License # | 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 13 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184626996 | NPPES |
| Georgia | MEDICAID | 100000351C |
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