Active NPI
Tracys Medicine Center
- Pharmacy
- Tucker, GA
National Provider Identifier
1790772473
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- PHRE005288
- Legal business name
- TRACYS MEDICINE CENTER
- Practice address
- 3171 Tucker Norcross Rd
Tucker, GA 30084-2124 - Phone
- (770) 939-1642
- Fax
- (770) 723-9515
- NPI assigned
- Sep 29, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Shannan Lynn Tracy
- Title
- Pharmacist in Charge
- Phone
- (770) 939-1642
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | PHRE005288 | GA | Primary |
Addresses
Primary practice location
3171 Tucker Norcross Rd
Tucker, GA 30084-2124
Mailing address
3171 Tucker Norcross Rd
Tucker, GA 30084-2124
Phone (770) 939-1642
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000422881B | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930006926 | GA | DME Supplier - Pharmacy | 3678690427 | Practice locations: Tucker, GA |
| O20181214001822 | GA | Part B Supplier - Mass Immunization (Roster Biller Only) | 3678690427 | Practice locations: Tucker, GA |
National Provider Directory
National Provider Directory- Tax ID family
- Tracys Medicine Center
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Long Term Care Pharmacy
- Tucker, GA
- NPI 1326706615
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127952000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1524614400000",
"number": "1790772473",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3171 TUCKER NORCROSS RD",
"city": "TUCKER",
"state": "GA",
"postal_code": "300842124",
"telephone_number": "770-939-1642",
"fax_number": "770-723-9515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3171 TUCKER NORCROSS RD",
"city": "TUCKER",
"state": "GA",
"postal_code": "300842124",
"telephone_number": "770-939-1642",
"fax_number": "770-723-9515"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TRACYS MEDICINE CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2005-09-29",
"last_updated": "2018-04-25",
"status": "A",
"authorized_official_last_name": "TRACY",
"authorized_official_first_name": "SHANNAN",
"authorized_official_middle_name": "LYNN",
"authorized_official_title_or_position": "PHARMACIST IN CHARGE",
"authorized_official_telephone_number": "770-939-1642"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "GA",
"license": "PHRE005288",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000422881B",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tucker, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.