Provider Demographics
NPI:1285050179
Name:WORLES, TRACY
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:WORLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 BALTIC ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-2401
Mailing Address - Country:US
Mailing Address - Phone:901-864-9523
Mailing Address - Fax:
Practice Address - Street 1:687 BALTIC ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-2401
Practice Address - Country:US
Practice Address - Phone:901-864-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-15
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN114001171172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver