Provider Demographics
NPI:1073083317
Name:CANTY, TRACY B
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:B
Last Name:CANTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 HUTCHISON LN
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3002
Mailing Address - Country:US
Mailing Address - Phone:229-359-5951
Mailing Address - Fax:
Practice Address - Street 1:2206 HUTCHISON LN
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3002
Practice Address - Country:US
Practice Address - Phone:229-359-5951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor