Provider Demographics
NPI:1922987262
Name:GAZZOLA, TRACY LYNNETTE (LMT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNNETTE
Last Name:GAZZOLA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5992 FIELDER WAY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-5721
Mailing Address - Country:US
Mailing Address - Phone:404-277-4004
Mailing Address - Fax:404-277-4004
Practice Address - Street 1:3417 HIGHWAY 5 STE G
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2378
Practice Address - Country:US
Practice Address - Phone:770-489-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-30
Last Update Date:2025-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT001453225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist