Traci L Wise, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT001130 Issued in GA

Practice address

104 Cardinal Rd
Woodbine, GA 31569-4318

Phone

(912) 576-2900

Fax

(912) 576-4906

NPI assigned

Jul 20, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Traci L McSween Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093735185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 CARDINAL RD",
            "city": "WOODBINE",
            "state": "GA",
            "postal_code": "315694318",
            "telephone_number": "912-674-0682",
            "fax_number": "912-576-4906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 CARDINAL RD",
            "city": "WOODBINE",
            "state": "GA",
            "postal_code": "315694318",
            "telephone_number": "912-576-2900",
            "fax_number": "912-576-4906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "TRACI",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT001130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACI",
            "last_name": "MCSWEEN",
            "middle_name": "L",
            "prefix": "MS.",
            "credential": "ATC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Athletic Trainer in Woodbine, GA
• Providers in Woodbine, GA by specialty
• Athletic Trainer in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.