Healthcare Provider Details

I. General information

NPI: 1851173017
Provider Name (Legal Business Name): TRACY GANEM MS, RDN, CSOWM, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY GANEM ROBERTS MS, RDN, CSOWM, LD

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 WHITESBURG DR SW STE 200
HUNTSVILLE AL
35802-1681
US

IV. Provider business mailing address

1318 AROLEN DR SE
HUNTSVILLE AL
35803-2627
US

V. Phone/Fax

Practice location:
  • Phone: 256-880-4510
  • Fax:
Mailing address:
  • Phone: 256-479-3925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number1175
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: