Healthcare Provider Details

I. General information

NPI: 1598283889
Provider Name (Legal Business Name): TRACY GEORGE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 S JONES BLVD
LAS VEGAS NV
89103-3370
US

IV. Provider business mailing address

1600 E UNIVERSITY AVE APT 103
LAS VEGAS NV
89119-5834
US

V. Phone/Fax

Practice location:
  • Phone: 702-991-3150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: