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General NPI Number Information
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NPI Number | 1912241654
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Entity Type | Organization
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Legal Business Name | TRACY MIDDLEBROOKS, MD
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 11/19/2012
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Provider Practice Location Address
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Address Line | 2315 CENTRAL AVE
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City | AUGUSTA
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State | GA
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Zip | 30904-6272
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Country | US
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Telephone | 706-667-0070
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Fax |
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Provider Business Mailing Address
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Address Line | 2315 CENTRAL AVE
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City | AUGUSTA
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State | GA
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Zip | 30904-6272
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Country | US
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Telephone | 706-667-0070
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRACY MIDDLEBROOKS
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Credential | MD
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Telephone | 706-667-0070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 021986
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License Number State | GA
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