Traci Giles Hackett, M.D.
Individual provider Active NPI Family Medicine Physician · Dothan, AL
NPI 1306931001 · NPPES record last updated Jan 6, 2014
Key facts
- NPI
- 1306931001
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 23561 (AL)
- Practice address
- 1836 W Main St
Dothan, AL 36301-1320 - Phone
- (334) 699-8585
- Fax
- (334) 699-8587
- NPI assigned
- Oct 4, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Rutgers New Jersey Medical School, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southern Immediate Care, LLC
Practice addresses (Care Compare)
104 Chelsea Point Dr
Chelsea, AL 35043-4100
Phone (205) 409-2794
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051109000342 | AL | Practitioner - Family Practice | 4385662899 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23561 | AL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stopwatch Urgent Care Centers LLC | Current |
Accepting new patients | |
| Southern Immediate Care, LLC | Current |
Accepting new patients |
Locations
4100 McClellan Blvd
Anniston, AL 36201
Phone (256) 235-2273
2415 Moores Mill Rd
Unit 230
Auburn, AL 36830
Phone (334) 502-1117
104 Chelsea Point Dr
Chelsea, AL 35043
Phone (205) 453-7550
110 Legacy Park Way
Springville, AL 35146
Phone (205) 719-1000
Interoperability endpoints
- https://api.platform.athenahealth.com/17814/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 23561 | AL | Yes |
Addresses
Primary practice location
1836 W Main St
Dothan, AL 36301-1320
Mailing address
5932 Lake Cyrus Dr
Hoover, AL 35244-4162
Phone (334) 300-7480
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 51530696 | Other | AL | BCBS |
| 529925720 | Medicaid | AL |
Other providers in Dothan, AL
- Gut PC
- Ramaseetha Gutta
- Jimmie Guyton
- Nelson Gwinn III
- Nelson Jonathan Gwinn
- Lance Hagler
- Robert M Hagler
- Hairoglyphics Hair and Beauty Salon
- John H. Haley Jr.
- Kelli Haley
All providers in Dothan, AL · Family Medicine Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 6, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.