MEDICARE: TRACEY MCGAUGH RNFA

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	163WR0006X	Registered Nurse First Assistant	094793	GA

General Provider Information

NPI Number	:	1518477256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY MCGAUGH RNFA

Provider Business Mailing Address
First Line	:	1560 OAK CREEK DR
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-4160
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1560 OAK CREEK DR
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-4160
Country	:	US
Telephone Number	:	404-630-7841
Fax Number	:	855-276-7112

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

Provider Enumeration Date	:	10/09/2017
Last Update Date	:	10/09/2017

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