Provider Demographics
NPI:1417716408
Name:GREEN, TRACY (HEALTHCARE)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:HEALTHCARE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E BESSEMER AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1416
Mailing Address - Country:US
Mailing Address - Phone:336-482-1708
Mailing Address - Fax:
Practice Address - Street 1:200 E BESSEMER AVE STE 100
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1416
Practice Address - Country:US
Practice Address - Phone:336-482-1708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness