Provider Demographics
NPI:1851173017
Name:GANEM, TRACY (MS, RDN, CSOWM, LD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:GANEM
Suffix:
Gender:F
Credentials:MS, RDN, CSOWM, LD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:GANEM
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN, CSOWM, LD
Mailing Address - Street 1:1318 AROLEN DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-2627
Mailing Address - Country:US
Mailing Address - Phone:256-479-3925
Mailing Address - Fax:
Practice Address - Street 1:4704 WHITESBURG DR SW STE 200
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1681
Practice Address - Country:US
Practice Address - Phone:256-880-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1175133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management