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General NPI Number Information
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NPI Number | 1306931001
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Entity Type | Individual
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Provider Name | TRACI GILES HACKETT M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 01/06/2014
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Provider Practice Location Address
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Address Line | 1836 W MAIN ST
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City | DOTHAN
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State | AL
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Zip | 36301-1320
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Country | US
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Telephone | 334-699-8585
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Fax | 334-699-8587
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Provider Business Mailing Address
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Address Line | 5932 LAKE CYRUS DR
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City | HOOVER
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State | AL
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Zip | 35244-4162
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Country | US
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Telephone | 334-300-7480
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 23561
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License Number State | AL
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