Provider Demographics
NPI:1801858527
Name:JONES, TRACY KATHLEEN (FNPC)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:KATHLEEN
Last Name:JONES
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 HOSPITAL SOUTH DR
Mailing Address - Street 2:SUITE 502 GASTROINTESTINAL SPECIALISTS OF GA, PC
Mailing Address - City:AUSTCEE
Mailing Address - State:GA
Mailing Address - Zip Code:30106
Mailing Address - Country:US
Mailing Address - Phone:678-741-5000
Mailing Address - Fax:
Practice Address - Street 1:6043 PRESTLEY MILL RD
Practice Address - Street 2:SUITE D
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134
Practice Address - Country:US
Practice Address - Phone:770-739-9555
Practice Address - Fax:678-741-2301
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN112762163W00000X, 363L00000X
GA0340729 22363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300035305BMedicaid
50BBDWCOtherMEDICARE
GA651375375AMedicaid
CEP12680OtherRN PROVIDER ID
GA000902327AMedicaid
GA651375375AMedicaid
GA300035305BMedicaid
GAP00200512Medicare ID - Type UnspecifiedMEDICARE RAILROAD