NPIMap

Organization Active NPI

Tracy E. Durham DDS PC

  • General Practice Dentistry
  • Pooler, GA
National Provider Identifier
1730214735
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN011541 Issued in GA
Legal business name
TRACY E. DURHAM DDS PC
Practice address
145 Traders Way
Suite D
Pooler, GA 31322-6005
Phone
(912) 748-4494
NPI assigned
Feb 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Tracy Ellen Durham, D.D.S.NPI 1366577322
Title
President
Phone
(912) 748-4494

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DN011541 GA Primary

Addresses

Primary practice location

145 Traders Way
Suite D
Pooler, GA 31322-6005

Mailing address

145 Traders Way
Suite D
Pooler, GA 31322-6005
Phone (912) 748-4494

National Provider Directory

National Provider Directory

Locations

145 Traders Way
Ste D
Pooler, GA 31322
Phone (912) 748-4494

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730214735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 TRADERS WAY",
            "address_2": "SUITE D",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313226005",
            "telephone_number": "912-748-4494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 TRADERS WAY",
            "address_2": "SUITE D",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313226005",
            "telephone_number": "912-748-4494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACY E. DURHAM DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DURHAM",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "912-748-4494",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN011541",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pooler, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.