Provider Demographics
NPI:1013979855
Name:EDWARDS, TRACY L (MD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:L
Last Name:EDWARDS
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:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:HIAWASSEE
Mailing Address - State:GA
Mailing Address - Zip Code:30546-0031
Mailing Address - Country:US
Mailing Address - Phone:706-896-6701
Mailing Address - Fax:706-896-6706
Practice Address - Street 1:86 SEASONS LANE
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546
Practice Address - Country:US
Practice Address - Phone:706-896-6701
Practice Address - Fax:706-896-6706
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000842872EMedicaid
GAGRP7451Medicare ID - Type Unspecified
GA08CBBCPMedicare ID - Type Unspecified
GA000842872EMedicaid