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General NPI Number Information
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NPI Number | 1992897714
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Entity Type | Individual
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Provider Name | TRACY WILLIAMS MIDDLEBROOKS JR. MD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 02/25/2019
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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 | 706-667-0073
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Provider Business Mailing Address
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Address Line | 1505 WINTER ST SUITE D
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City | AUGUSTA
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State | GA
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Zip | 30904
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Country | US
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Telephone | 706-667-0070
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Fax | 706-667-0073
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 24986
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License Number State | GA
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