MEDICARE: MRS. TRACY PRIVETTE GEORGE F.N.P.

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	363LF0000X	Family Nurse Practitioner	APN1519	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669466710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACY PRIVETTE GEORGE F.N.P.

Provider Business Mailing Address
First Line	:	230 CHURCH ST
Second Line	:
City	:	LATTA
State	:	SC
Zip	:	29565-1306
Country	:	US
Telephone Number	:	843-752-7667
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 W HAMPTON ST
Second Line	:
City	:	DILLON
State	:	SC
Zip	:	29536-3333
Country	:	US
Telephone Number	:	843-774-5611
Fax Number	:

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	07/21/2008

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