Provider Demographics
NPI:1588848485
Name:TRACEY R. LEMON, M.D., P.C.
Entity Type:Organization
Organization Name:TRACEY R. LEMON, M.D., P.C.
Other - Org Name:GEORGIA CENTER FOR WOMEN/TRACEY R LEMON MD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-265-6888
Mailing Address - Street 1:315 BOULEVARD NE STE 224
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1220
Mailing Address - Country:US
Mailing Address - Phone:404-265-6888
Mailing Address - Fax:404-880-0807
Practice Address - Street 1:315 BOULEVARD NE STE 224
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1220
Practice Address - Country:US
Practice Address - Phone:404-265-6888
Practice Address - Fax:404-880-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA050723207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000934227DMedicaid
GA16BBCTRMedicare PIN