Provider Demographics
NPI:1679689285
Name:CALLISTER, TRACY Q (MD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:Q
Last Name:CALLISTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 NEW SHACKLE ISLAND RD
Mailing Address - Street 2:#300C
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2379
Mailing Address - Country:US
Mailing Address - Phone:615-338-3337
Mailing Address - Fax:615-338-3329
Practice Address - Street 1:353 NEW SHACKLE ISLAND RD
Practice Address - Street 2:#300C
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2379
Practice Address - Country:US
Practice Address - Phone:615-338-3337
Practice Address - Fax:615-338-3329
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15550207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3007822Medicaid
TN3007827Medicare ID - Type Unspecified
TN3007822Medicaid