Provider Demographics
NPI:1053658765
Name:AUTERA, TRACI (DC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:AUTERA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2466
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-0466
Mailing Address - Country:US
Mailing Address - Phone:770-487-5211
Mailing Address - Fax:770-487-5950
Practice Address - Street 1:1952 HIGHWAY 54 W
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4781
Practice Address - Country:US
Practice Address - Phone:770-487-5211
Practice Address - Fax:770-487-5950
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor