Provider Demographics
NPI:1578992970
Name:ROLLE, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:ROLLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3485 N DESERT DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5724
Mailing Address - Country:US
Mailing Address - Phone:404-941-9350
Mailing Address - Fax:404-941-9606
Practice Address - Street 1:3485 N DESERT DR
Practice Address - Street 2:SUITE 104
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5724
Practice Address - Country:US
Practice Address - Phone:404-941-9350
Practice Address - Fax:404-941-9606
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No252Y00000XAgenciesEarly Intervention Provider Agency