Provider Demographics
NPI:1659433662
Name:PURVIS, TRACIE ELIZABETH (SA-C)
Entity Type:Individual
Prefix:
First Name:TRACIE
Middle Name:ELIZABETH
Last Name:PURVIS
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:TRACIE
Other - Middle Name:ELIZABETH
Other - Last Name:PURVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5181
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31414-5181
Mailing Address - Country:US
Mailing Address - Phone:912-596-1783
Mailing Address - Fax:912-231-1102
Practice Address - Street 1:1013 PERRY CV
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-1808
Practice Address - Country:US
Practice Address - Phone:912-596-1783
Practice Address - Fax:912-231-1102
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant