Provider Demographics
NPI:1538106471
Name:CORDONE, TRACY (RD, LD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:CORDONE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 MONTREAL RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6929
Mailing Address - Country:US
Mailing Address - Phone:770-674-5458
Mailing Address - Fax:770-674-1871
Practice Address - Street 1:1462 MONTREAL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6929
Practice Address - Country:US
Practice Address - Phone:770-674-5458
Practice Address - Fax:770-674-1871
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001245133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA71BBBJJMedicare ID - Type Unspecified
GA71BBBSVMedicare ID - Type Unspecified
GAP81004Medicare UPIN