Provider Demographics
NPI:1578298386
Name:TRACYS WELLNESS CLINIC
Entity Type:Organization
Organization Name:TRACYS WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-850-0417
Mailing Address - Street 1:3171 TUCKER NORCROSS RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-2124
Mailing Address - Country:US
Mailing Address - Phone:404-850-0417
Mailing Address - Fax:
Practice Address - Street 1:3171 TUCKER NORCROSS RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-2124
Practice Address - Country:US
Practice Address - Phone:404-850-0417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service