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General NPI Number Information
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NPI Number | 1710279955
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Entity Type | Individual
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Provider Name | TRACEY LYNN HENRY
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Gender | Female
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Dates
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Enumeration Date | 05/06/2011
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Last Update Date | 04/18/2016
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Provider Practice Location Address
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Address Line | 49 JESSE HILL JR DR SE FOB SUITE 483
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City | ATLANTA
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State | GA
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Zip | 30303-3049
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Country | US
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Telephone | 404-251-8908
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Fax |
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Provider Business Mailing Address
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Address Line | 49 JESSE HILL JR DR SE FOB SUITE 483
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City | ATLANTA
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State | GA
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Zip | 30303-3049
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Country | US
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Telephone | 404-251-8908
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 390200000XL
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 042583
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 206179
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 75124
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License Number State | GA
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