Healthcare Provider Details

I. General information

NPI: 1346605920
Provider Name (Legal Business Name): TRAXLER PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 LAUREL SPRINGS PKWY SUITE 1402
SUWANEE GA
30024-6056
US

IV. Provider business mailing address

5400 LAUREL SPRINGS PKWY SUITE 1402
SUWANEE GA
30024-6056
US

V. Phone/Fax

Practice location:
  • Phone: 678-965-0586
  • Fax: 877-500-8092
Mailing address:
  • Phone: 678-965-0586
  • Fax: 877-500-8092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: MRS. AMIE HUNTER CHEEK
Title or Position: OFFICE MANAGER
Credential: CPC
Phone: 678-965-0586