Provider Demographics
NPI:1023085602
Name:PARKS, TRACY MORRISON (MD)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:MORRISON
Last Name:PARKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:TRACY
Other - Middle Name:KAREN
Other - Last Name:MORRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:586 MORRIS MAJESTIC RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:AL
Mailing Address - Zip Code:35116-1245
Mailing Address - Country:US
Mailing Address - Phone:205-933-4242
Mailing Address - Fax:205-647-0561
Practice Address - Street 1:586 MORRIS MAJESTIC RD
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:AL
Practice Address - Zip Code:35116-1245
Practice Address - Country:US
Practice Address - Phone:205-933-4242
Practice Address - Fax:205-647-0561
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00017426207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051504708OtherBLUE SHIELD
AL303769362Medicaid
ALG590OtherMEDICARE GROUP NUMBER
AL1700891538OtherMEDICARE GROUP G590 NPI
AL303769362Medicaid
ALF84060Medicare UPIN