Provider Demographics
NPI:1417120841
Name:BATTLE, TRACIE M
Entity Type:Individual
Prefix:DR
First Name:TRACIE
Middle Name:M
Last Name:BATTLE
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:PO BOX 1777
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:AL
Mailing Address - Zip Code:35762-1777
Mailing Address - Country:US
Mailing Address - Phone:256-859-0902
Mailing Address - Fax:
Practice Address - Street 1:5045 N MEMORIAL PKWY
Practice Address - Street 2:STE.D
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-1077
Practice Address - Country:US
Practice Address - Phone:256-859-0902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL53121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009961335Medicaid