Provider Demographics
NPI:1851944524
Name:SCURLOCK, TRACEY BERNARD JR
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:BERNARD
Last Name:SCURLOCK
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-8064
Mailing Address - Country:US
Mailing Address - Phone:901-687-1913
Mailing Address - Fax:
Practice Address - Street 1:3747 EUREKA RD
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-8064
Practice Address - Country:US
Practice Address - Phone:901-687-1913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care