Healthcare Provider Details

I. General information

NPI: 1619962206
Provider Name (Legal Business Name): TRACY HOOPER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. TRACY MARTIN

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 GI MADDOX PARKWAY
CHATSWORTH GA
30705-2147
US

IV. Provider business mailing address

PO BOX 12938 C/O CLINIC MANAGEMENT
CALHOUN GA
30703
US

V. Phone/Fax

Practice location:
  • Phone: 706-695-0561
  • Fax: 706-695-8678
Mailing address:
  • Phone: 706-602-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP095695
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: