Provider Demographics
NPI:1346605920
Name:TRAXLER PRIMARY CARE, LLC
Entity Type:Organization
Organization Name:TRAXLER PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMIE
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:CHEEK
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:678-965-0586
Mailing Address - Street 1:5400 LAUREL SPRINGS PKWY
Mailing Address - Street 2:SUITE 1402
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6056
Mailing Address - Country:US
Mailing Address - Phone:678-965-0586
Mailing Address - Fax:877-500-8092
Practice Address - Street 1:5400 LAUREL SPRINGS PKWY
Practice Address - Street 2:SUITE 1402
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6056
Practice Address - Country:US
Practice Address - Phone:678-965-0586
Practice Address - Fax:877-500-8092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty