Provider Demographics
NPI:1427686245
Name:POLLOCK, TRACY BECK
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:BECK
Last Name:POLLOCK
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 1:233 NORTHWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:DUDLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31022-6503
Mailing Address - Country:US
Mailing Address - Phone:478-290-9443
Mailing Address - Fax:
Practice Address - Street 1:1006 HILLCREST PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-4260
Practice Address - Country:US
Practice Address - Phone:478-272-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-28
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA184103363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care