MEDICARE: MS. TRACY JUJARA

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1528840436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACY JUJARA

Provider Business Mailing Address
First Line	:	3292 ERNEST W BARRETT PKWY NW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-1872
Country	:	US
Telephone Number	:	470-531-5940
Fax Number	:

Provider Business Practice Location Address
First Line	:	3292 BARRETT PKWY NW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-1872
Country	:	US
Telephone Number	:	470-531-5940
Fax Number	:

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

Provider Enumeration Date	:	10/16/2023
Last Update Date	:	10/16/2023

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