Provider Demographics
NPI:1932870052
Name:MCGARVEY, TRACY DISHON (RN,ADMINISTRATOR)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:DISHON
Last Name:MCGARVEY
Suffix:
Gender:F
Credentials:RN,ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 WESLEY STONECREST CIR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-2567
Mailing Address - Country:US
Mailing Address - Phone:404-488-4821
Mailing Address - Fax:
Practice Address - Street 1:3295 RIVER EXCHANGE DR
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-4241
Practice Address - Country:US
Practice Address - Phone:404-488-4821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN270799163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA853164851OtherINSURERS