Basic Information
| Provider Information | |||||||||
| NPI: | 1134512635 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | TRACI | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | APRN, CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2295 TOWNE LAKE PKWY STE 116-257 | ||||||||
| Address2: | |||||||||
| City: | WOODSTOCK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301895520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786535828 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 NORTHMEADOW PKWY | ||||||||
| Address2: | |||||||||
| City: | ROSWELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300764924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706644430 | ||||||||
| FaxNumber: | 7706647836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2015 | ||||||||
| LastUpdateDate: | 10/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | RN216264 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.