Healthcare Provider Details

I. General information

NPI: 1063404945
Provider Name (Legal Business Name): TRACY M TIMONY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 S. HERLONG AVE STE 102
ROCK HILL SC
29732
US

IV. Provider business mailing address

1665 HERLONG CT STE A
ROCK HILL SC
29732
US

V. Phone/Fax

Practice location:
  • Phone: 803-324-8004
  • Fax:
Mailing address:
  • Phone: 803-324-8004
  • Fax: 803-323-6472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number15793
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15793
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD15793
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: