Basic Information
| Provider Information | |||||||||
| NPI: | 1801858527 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | KATHLEEN | ||||||||
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| Credential: | FNP.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 HOSPITAL SOUTH DR | ||||||||
| Address2: | SUITE 502 GASTROINTESTINAL SPECIALISTS OF GA, PC | ||||||||
| City: | AUSTCEE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787415000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6043 PRESTLEY MILL RD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | DOUGLASVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707399555 | ||||||||
| FaxNumber: | 6787412301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 07/29/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN112762 | GA | N | Nursing Service Providers | Registered Nurse | 363L00000X | RN112762 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 0340729 22 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 300035305B | 05 | GA | MEDICAID | 50BBDWC | 01 | MEDICARE | OTHER | 651375375A | 05 | GA | MEDICAID | CEP12680 | 01 | RN PROVIDER ID | OTHER | 000902327A | 05 | GA | MEDICAID |