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General NPI Number Information
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NPI Number | 1780669739
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Entity Type | Individual
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Provider Name | TRACY ELIZABETH WIMBUSH MD
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Gender | Female
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 06/03/2014
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Provider Practice Location Address
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Address Line | 1240 EAGLES LANDING PKWY SUITE 300
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City | STOCKBRIDGE
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State | GA
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Zip | 30281
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Country | US
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Telephone | 770-506-4350
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Fax | 770-506-9860
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Provider Business Mailing Address
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Address Line | 900 CIRCLE 75 PKWY SE SUITE 1700
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City | ATLANTA
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State | GA
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Zip | 30339-3035
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Country | US
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Telephone | 770-953-6929
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Fax | 770-953-6972
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 213411
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 243910
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD433123
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | MD433123
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License Number State | PA
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Taxonomy #5
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 068869
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License Number State | GA
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