Provider Demographics
NPI:1073038667
Name:ADAMS, TRACY DELANE (ABC CO, AL & TN LO)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:DELANE
Last Name:ADAMS
Suffix:
Gender:M
Credentials:ABC CO, AL & TN LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 BOB WALLACE AVE SW STE B
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-4166
Mailing Address - Country:US
Mailing Address - Phone:256-203-2647
Mailing Address - Fax:
Practice Address - Street 1:2905 BOB WALLACE AVE SW STE B
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-4166
Practice Address - Country:US
Practice Address - Phone:256-203-2647
Practice Address - Fax:256-203-2565
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL72222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty