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General NPI Number Information
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NPI Number | 1205834637
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Entity Type | Individual
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Provider Name | MR. TRACEY R DAILEY
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Gender | Male
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Dates
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Enumeration Date | 07/10/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1100 E WALNUT AVE SUITE 16
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City | DALTON
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State | GA
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Zip | 30721-4183
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Country | US
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Telephone | 706-226-6000
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Fax | 706-226-3786
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Provider Business Mailing Address
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Address Line | 2461 HIGHWAY 225 S
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City | CHATSWORTH
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State | GA
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Zip | 30705-6042
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Country | US
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Telephone | 706-517-4600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH016829
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License Number State | GA
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