Provider Demographics
NPI:1881658201
Name:LEMON, TRACEY R (MD)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:R
Last Name:LEMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 BOULEVARD NE
Mailing Address - Street 2:STE 224
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1200
Mailing Address - Country:US
Mailing Address - Phone:404-265-6888
Mailing Address - Fax:404-880-0807
Practice Address - Street 1:315 BOULEVARD NE
Practice Address - Street 2:STE 224
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1200
Practice Address - Country:US
Practice Address - Phone:404-265-6888
Practice Address - Fax:404-880-0807
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA050723207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000934227DMedicaid
GA16BBCTRMedicare ID - Type Unspecified
GA000934227DMedicaid