MEDICARE: MR. TRACEY R DAILEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH016829	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RPH016829	OTHER	GA	PHARMACIST LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	PHRE008559	OTHER	GA	PHARMACY LICENSE NO

General Provider Information

NPI Number	:	1205834637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TRACEY R DAILEY

Provider Business Mailing Address
First Line	:	2461 HIGHWAY 225 S
Second Line	:
City	:	CHATSWORTH
State	:	GA
Zip	:	30705-6042
Country	:	US
Telephone Number	:	706-517-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 E WALNUT AVE
Second Line	:	SUITE 16
City	:	DALTON
State	:	GA
Zip	:	30721-4183
Country	:	US
Telephone Number	:	706-226-6000
Fax Number	:	706-226-3786

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2005
Last Update Date	:	03/07/2023

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Directions to “ MR. TRACEY R DAILEY ” Practice Location

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