Provider Demographics
NPI:1619510724
Name:ALSTON, TRACEY Q
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:Q
Last Name:ALSTON
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 1:10 FRANKLINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-4795
Mailing Address - Country:US
Mailing Address - Phone:336-840-6647
Mailing Address - Fax:
Practice Address - Street 1:10 FRANKLINWOOD DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-4795
Practice Address - Country:US
Practice Address - Phone:336-840-6647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver