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General NPI Number Information
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NPI Number | 1669466710
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Entity Type | Individual
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Provider Name | TRACY PRIVETTE GEORGE F.N.P.
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Gender | Female
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Dates
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Enumeration Date | 09/06/2005
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 201 W HAMPTON ST
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City | DILLON
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State | SC
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Zip | 29536-3333
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Country | US
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Telephone | 843-774-5611
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Fax |
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Provider Business Mailing Address
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Address Line | 230 CHURCH ST
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City | LATTA
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State | SC
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Zip | 29565-1306
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Country | US
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Telephone | 843-752-7667
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN1519
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License Number State | SC
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