Provider Demographics
NPI:1376642314
Name:MERRILL, TRACY ANN (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:MERRILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3785 CHATTAHOOCHEE SUMMIT DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3246
Mailing Address - Country:US
Mailing Address - Phone:404-575-2238
Mailing Address - Fax:
Practice Address - Street 1:1405 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1060
Practice Address - Country:US
Practice Address - Phone:404-785-7485
Practice Address - Fax:404-785-7498
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0532692080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA93BBHBGMedicare ID - Type UnspecifiedPROVIDER NUMBER