Provider Demographics
NPI:1568452621
Name:MCELVEEN, TRACY L (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:L
Last Name:MCELVEEN
Suffix:
Gender:F
Credentials:MD
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 116470
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6470
Mailing Address - Country:US
Mailing Address - Phone:770-979-3705
Mailing Address - Fax:770-978-9986
Practice Address - Street 1:1770 PRESIDENTIAL CIR
Practice Address - Street 2:DEPARTMENT OF RADIATION ONCOLOGY
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5643
Practice Address - Country:US
Practice Address - Phone:770-979-3705
Practice Address - Fax:770-978-9986
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA56592174400000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA799593678GMedicaid
GA202I920435Medicare UPIN
GA799593678GMedicaid