TRACY CROCKETT (NPI# 1184626996) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184626996 |
| Entity Type | Individual |
| Full Name | TRACY CROCKETT |
| Credential | P.A. |
| Practice Address |
2470 Daniels Bridge Rd Bldg 200 Suite 251 Athens GA 30606-6187 |
| Mailing Address |
1131 Golf Course Ln Athens GA 30605-5350 |
| Practice Telephone | 7063893440 |
| Practice Fax Number | 7063532771 |
| Mailing Telephone | 7066131518 |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2013-02-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
1763 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 100000351C | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568011807 | Tracy Crockett | Technician | 36408 Cognac St, Winchester, CA 92596-9108 | 2019-09-10 |
| Street Address |
2470 DANIELS BRIDGE RD BLDG 200 SUITE 251 |
| City | ATHENS |
| State | GA |
| Zip Code | 30606-6187 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942208970 | Harvey G Ouzts | Internal Medicine | 2470 Daniels Bridge Rd, Bldg 200, Ste 251, Athens, GA 30606-6187 | 2005-07-13 |
| 1588293898 | Haley Lee | Nurse Practitioner | 2470 Daniels Bridge Rd, Athens, GA 30606-6187 | 2020-04-07 |
| 1245783141 | Laura Rae Stark | Occupational Therapist | 2470 Daniels Bridge Rd, Bldg 300, Athens, GA 30606-6187 | 2016-07-27 |
| 1184075178 | Kristen Brewer Power | Occupational Therapist | 2470 Daniels Bridge Rd, Bldg. 300, Athens, GA 30606-6187 | 2016-06-30 |
| 1437500899 | Antonia Elizabeth Adams | Occupational Therapist | 2470 Daniels Bridge Rd, Athens, GA 30606-6187 | 2016-06-28 |
| 1689057234 | St. Mary's Medical Group, Inc. | Internal Medicine | 2470 Daniels Bridge Rd, Bldg 200 Suite 221, Athens, GA 30606-6187 | 2015-07-01 |
| 1457731689 | Stephanie Witt | Nurse Practitioner | 2470 Daniels Bridge Rd, Building 200, Suite 251, Athens, GA 30606-6187 | 2015-06-03 |
| 1780064816 | Christina Frances Keller | Nurse Practitioner | 2470 Daniels Bridge Rd, Bldg 200, Suite 251, Athens, GA 30606-6187 | 2015-06-03 |
| 1962800136 | Dc Anesthesia, LLC | Nurse Anesthetist, Certified Registered | 2470 Daniels Bridge Rd, Building 100 Suite 151, Athens, GA 30606-6187 | 2014-12-19 |
| 1578961694 | Kimberly Kelley | Nurse Practitioner | 2470 Daniels Bridge Rd, Building 200, Suite 251, Athens, GA 30606-6187 | 2014-12-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942816962 | Kofi Darkwa Seffah | Student in an Organized Health Care Education/Training Program | 1199 Prince Ave #70, 1270 Prince Ave Suite 201, Athens, GA 30606 | 2020-09-16 |
| 1831712363 | Rebecca John | Licensed Practical Nurse | 240 Mitchel Bridge Road, Athens, GA 30606 | 2020-05-19 |
| 1497375612 | Alfred Ka-shing Wong | Student in an Organized Health Care Education/Training Program | 1270 Prince Ave Suite 201, Athens, GA 30606 | 2020-04-17 |
| 1881223956 | Lauren Fesperman | Nurse Practitioner | 242 King Ave Ste 130, Athens, GA 30606 | 2020-04-02 |
| 1255966081 | Westminster Presbyterian Homes, Inc. | Skilled Nursing Facility | 1400 Live Oak Ln, Building 100, Athens, GA 30606 | 2020-03-12 |
| 1255981700 | Carol Cameron Cready-pyle | Social Worker | 1551 Jennings Mill Pkwy Ste 1700, Athens, GA 30606 | 2019-09-17 |
| 1013576016 | Lauren Gruendling | Nurse Practitioner | 242 King Avenue, Suite 210, Athens, GA 30606 | 2019-06-12 |
| 1760045223 | Dominic Ofosu Amakye | Student in an Organized Health Care Education/Training Program | 1270 Prince Avenue Suite 201, Athens, GA 30606 | 2019-04-19 |
| 1740740422 | Juan G Salazar Castillo | Student in an Organized Health Care Education/Training Program | Community Internal Medicine of Athens, 1500 Oglethorpe Ave Suite 200d, Athens, GA 30606 | 2019-03-20 |
| 1750869020 | Jennifer Emily Chapman | Physical Therapist | 1021 Parkway Blvd Ste 101, Athens, GA 30606 | 2018-07-30 |
| Find all providers in zip 30606 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003257163 | Kalen Elizabeth Ashford | Physician Assistant | 1061 Dowdy Rd Ste 202, Athens, GA 30606-5700 | 2013-07-17 |
| 1427367192 | Julie Michelle Key | Physician Assistant | 1270 Prince Avenue Suite 103, Athens, GA 30606 | 2010-09-29 |
| 1992740682 | Heather Coates | Physician Assistant | 135 N Meadows Dr, Suite B, Athens, TN 37303-4172 | 2006-06-18 |
| 1922046267 | Rishia L Brown | Physician Assistant | 1480 Baxter St Ste A, Athens, GA 30606 | 2006-06-02 |
| 1598370553 | Olivia James | Physician Assistant | 2 Health Center Dr, Athens, OH 45701-2907 | 2020-09-15 |
| 1114548559 | Kristina Louise Kauffman | Physician Assistant | 2142 W Broad St Ste 200, Athens, GA 30606-3506 | 2020-04-27 |
| 1124501184 | Anna Cauthen Mcfather | Physician Assistant | 3320 Old Jefferson Road, Bldg 700, Athens, GA 30607 | 2018-09-14 |
| 1013498849 | Mary Rougeau Browning | Physician Assistant | 3320 Old Jefferson Road, Bldg 700, Athens, GA 30607 | 2018-08-29 |
| 1821541152 | Mary Olivia Clark | Physician Assistant | 2142 W Broad St, Bldg 100 Ste 200, Athens, GA 30606-3506 | 2016-08-03 |
| 1881072379 | Athens Associates In Family Practice | Physician Assistant | 300 Hawthorne Ln, Athens, GA 30606-2152 | 2015-05-15 |
| Find all providers in ATHENS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.