Traces Trinity, LLC

Primary specialty

Adult CompanionTaxonomy code 372600000X

Legal business name

TRACES TRINITY, LLC

Practice address

92 Bettys Creek Rd
Dillard, GA 30537-2257

Phone

(706) 746-6571

Fax

(706) 746-5643

NPI assigned

Aug 28, 2016

Last updated

Aug 28, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Carlie Suzanne Pennington

Title

Sole MB

Phone

(706) 746-6571

Specialties & licenses 1

Addresses

Other names 1

• Traces of Tiger Adult Day Care Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472342400000",
    "number": "1043766348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "382 BRIDGE CREEK ROAD",
            "city": "TIGER",
            "state": "GA",
            "postal_code": "30576",
            "telephone_number": "706-782-6208",
            "fax_number": "706-782-5019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92 BETTYS CREEK RD",
            "city": "DILLARD",
            "state": "GA",
            "postal_code": "305372257",
            "telephone_number": "706-746-6571",
            "fax_number": "706-746-5643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACES TRINITY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-28",
        "last_updated": "2016-08-28",
        "status": "A",
        "authorized_official_last_name": "PENNINGTON",
        "authorized_official_first_name": "CARLIE",
        "authorized_official_middle_name": "SUZANNE",
        "authorized_official_title_or_position": "SOLE MB",
        "authorized_official_telephone_number": "706-746-6571",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "372600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Adult Companion",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Traces of Tiger Adult Day Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Charles Royce Pennington, M.D.
• Richard Howe Vollmer, DDS

• Adult Companion in Dillard, GA
• Providers in Dillard, GA by specialty
• Adult Companion in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.