Healthcare Provider Details

I. General information

NPI: 1518477256
Provider Name (Legal Business Name): TRACEY MCGAUGH RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 OAK CREEK DR
MARIETTA GA
30066-4160
US

IV. Provider business mailing address

1560 OAK CREEK DR
MARIETTA GA
30066-4160
US

V. Phone/Fax

Practice location:
  • Phone: 404-630-7841
  • Fax: 855-276-7112
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number094793
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: