Tracy Medicine of Atlanta Ga Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

15042 Issued in GA

Legal business name

TRACY MEDICINE OF ATLANTA GA INC

Practice address

3650 Chamblee Tucker Rd
Chamblee, GA 30341-4420

Phone

(770) 934-7703

Fax

(770) 414-1463

NPI assigned

Sep 2, 2005

Organization subpart

No

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

Authorized official

Name

Shannan Lynn Tracy, PHARMACIST

Title

President/Owner

Phone

(770) 934-7703

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• MEDICINE CENTER OF ATLANTA, INC Doing business as

Locations

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

{
    "created_epoch": "1125619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627516800000",
    "number": "1962496166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 CHAMBLEE TUCKER RD",
            "city": "CHAMBLEE",
            "state": "GA",
            "postal_code": "303414420",
            "telephone_number": "770-934-7703",
            "fax_number": "770-414-1463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3650 CHAMBLEE TUCKER RD",
            "city": "CHAMBLEE",
            "state": "GA",
            "postal_code": "303414420",
            "telephone_number": "770-934-7703",
            "fax_number": "770-414-1463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACY MEDICINE OF ATLANTA GA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-02",
        "last_updated": "2021-07-29",
        "certification_date": "2021-07-29",
        "status": "A",
        "authorized_official_last_name": "TRACY",
        "authorized_official_first_name": "SHANNAN",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "770-934-7703",
        "authorized_official_credential": "PHARMACIST"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": "4501",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "GA",
            "license": "15042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP NUMBER",
            "identifier": "1107588",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICINE CENTER OF ATLANTA, INC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MEDICINE CENTER OF ATLANTA, INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Oluwaseun O Togunde, LCSW
• Selamawit T Tolla
• Thomas Mitchell Toomey
• Luis Miguel Torres
• Robert W Toth, DC
• Habiba Jessica Tran, LAPC
• Lori Tran, DPT
• Janette Marie Troche, RDH
• Rachele Ulysse, PT
• Isabella Vazirani

• Pharmacy in Chamblee, GA
• Providers in Chamblee, GA by specialty
• Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2021; 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.