MEDICARE: MEGAN DEANNE TRACY

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1790273597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN DEANNE TRACY

Provider Business Mailing Address
First Line	:	6300 HOSPITAL PKWY STE 100
Second Line	:
City	:	JOHNS CREEK
State	:	GA
Zip	:	30097-1829
Country	:	US
Telephone Number	:	770-771-6591
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 HOSPITAL PKWY STE 100
Second Line	:
City	:	JOHNS CREEK
State	:	GA
Zip	:	30097-1829
Country	:	US
Telephone Number	:	770-771-6591
Fax Number	:

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

Provider Enumeration Date	:	04/26/2018
Last Update Date	:	04/26/2018

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Directions to “ MEGAN DEANNE TRACY ” Practice Location

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