Provider Demographics
NPI:1891903746
Name:BYRAM, TRACEY LEIGH (MS)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:LEIGH
Last Name:BYRAM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 HOSPITAL DR
Mailing Address - Street 2:SUITE 7G
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6393
Mailing Address - Country:US
Mailing Address - Phone:404-918-4763
Mailing Address - Fax:404-918-4763
Practice Address - Street 1:717 MATHESON DRIVE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2339
Practice Address - Country:US
Practice Address - Phone:478-251-9687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional