Healthcare Provider Details

I. General information

NPI: 1073038667
Provider Name (Legal Business Name): TRACY DELANE ADAMS ABC CO, AL & TN LO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 08/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 BOB WALLACE AVE SW STE B
HUNTSVILLE AL
35805-4166
US

IV. Provider business mailing address

2905 BOB WALLACE AVE SW STE B
HUNTSVILLE AL
35805-4166
US

V. Phone/Fax

Practice location:
  • Phone: 256-203-2647
  • Fax: 256-203-2565
Mailing address:
  • Phone: 256-203-2647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number72
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: