Provider Demographics
NPI:1659416071
Name:TRACY SMITH MAYBERRY
Entity Type:Organization
Organization Name:TRACY SMITH MAYBERRY
Other - Org Name:A PLUS FAMILY FOOT AND LEG CARE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:MAYBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:404-766-6400
Mailing Address - Street 1:1683 WASHINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-4265
Mailing Address - Country:US
Mailing Address - Phone:404-766-6400
Mailing Address - Fax:404-766-6450
Practice Address - Street 1:1683 WASHINGTON ROAD
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-4265
Practice Address - Country:US
Practice Address - Phone:404-766-6400
Practice Address - Fax:404-766-6450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000763213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA480028687OtherRAILROAD MEDICARE
GA000672119FMedicaid
GAU57852Medicare UPIN
GA48SCBRX01Medicare PIN