Provider Demographics
NPI:1437626405
Name:TOWNSELL, TRACY LYNN JR
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:TOWNSELL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 NIXON DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31705-9587
Mailing Address - Country:US
Mailing Address - Phone:229-903-9778
Mailing Address - Fax:
Practice Address - Street 1:1246 NIXON DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31705-9587
Practice Address - Country:US
Practice Address - Phone:229-903-9778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor