Healthcare Provider Details

I. General information

NPI: 1609457662
Provider Name (Legal Business Name): TRACY D ADAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 1ST AVE
LAWRENCEBURG TN
38464-2762
US

IV. Provider business mailing address

2905 BOB WALLACE AVE SE SUITE B
HUNTSVILLE AL
35805
US

V. Phone/Fax

Practice location:
  • Phone: 931-244-7558
  • Fax: 931-244-7560
Mailing address:
  • Phone: 256-203-2647
  • Fax: 256-964-8134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: TRACY D ADAMS
Title or Position: OWNER
Credential:
Phone: 931-244-7558