Provider Demographics
NPI:1407879851
Name:LATZ, TRACY THOMPSON (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:THOMPSON
Last Name:LATZ
Suffix:
Gender:F
Credentials:MD, MS
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Mailing Address - Street 1:116 S MAIN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2373
Mailing Address - Country:US
Mailing Address - Phone:704-662-3200
Mailing Address - Fax:704-662-3288
Practice Address - Street 1:116 S MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2373
Practice Address - Country:US
Practice Address - Phone:704-662-3200
Practice Address - Fax:704-662-3288
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC346602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
41028OtherABPN CERT. # EXP. 2014
NC51148OtherBCBS
NC7951148Medicaid
NCNC 34660OtherSTATE LICENSE
NC58366OtherMEDCOST
NC58366OtherMEDCOST
NC7951148Medicaid
NCNC 34660OtherSTATE LICENSE