MRS. TRACI L WISE (NPI# 1093735185) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093735185 |
| Entity Type | Individual |
| Full Name | MRS. TRACI L WISE |
| Other Name | MS. TRACI L MCSWEEN |
| Credential | ATC |
| Practice Address |
104 Cardinal Rd Woodbine GA 31569-4318 |
| Practice Telephone | 9125762900 |
| Practice Fax Number | 9125764906 |
| Mailing Telephone | 9126740682 |
| Mailing Fax Number | 9125764906 |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
AT001130 | GA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
104 CARDINAL RD |
| City | WOODBINE |
| State | GA |
| Zip Code | 31569-4318 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326281783 | Phyllis Dunham | Counselor | 349 Colesburg-tompkin Rd., Woodbine, GA 31569 | 2009-04-15 |
| 1063545762 | Gateway Behavioral Health Services | Psychologist | 210 East 15th Street, Woodbine, GA 31569 | 2007-03-13 |
| 1417099755 | Coastal Speech Therapy | Speech-Language Pathologist | 24 Serenity Farms Rd, Coastal Speech Therapy, Woodbine, GA 31569 | 2007-02-13 |
| 1790755585 | Kim Timmerman Baird | Nurse Practitioner | 308 Bedell Ave, Woodbine, GA 31569-0307 | 2006-01-24 |
| 1750508602 | Kim T. Baird, Fnp-cs | Nurse Practitioner | 308 Bedell Ave, Woodbine, GA 31569-0308 | 2007-04-20 |
| 1538386370 | Mary Lee Carter, Md-pc | Internal Medicine | 308 Bedell Ave, Woodbine, GA 31569-0308 | 2007-04-20 |
| 1720180573 | Robert Thomas Baird | Dentist | 308 Bedell Ave, Woodbine, GA 31569-0488 | 2006-09-02 |
| 1851710685 | Amanda Mcnulty | Nurse Practitioner | 308 Bedell Ave, Woodbine, GA 31569-2091 | 2014-04-09 |
| 1326484411 | Debra M. Tait | Counselor | 801 Thrift Rd, Woodbine, GA 31569-2436 | 2013-05-15 |
| 1043826241 | Jimmequia Lanice Allen | Registered Nurse | 117 James St, Woodbine, GA 31569-3568 | 2020-09-22 |
| Find all providers in zip 31569 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902330582 | Caragh Macdermott | Specialist/Technologist | 14954 Bushy Park Rd, Woodbine, MD 21797-8318 | 2017-04-20 |
| 1689172306 | Jacob Daniel Newsome | Specialist/Technologist | 5 Lindsay Ln, Woodbine, NJ 08270-3126 | 2018-01-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407455959 | Mary Lee Richardson | Specialist/Technologist | 1591 Glenn Pl Sw, Mableton, GA 30126-1170 | 2020-10-25 |
| 1295332914 | Cayla Mckeon | Specialist/Technologist | 11 W 11th St Apt 17, Columbus, GA 31901-4239 | 2020-10-06 |
| 1205442472 | Si'ara Washington Farris | Specialist/Technologist | 564 Hillandale Park Dr, Lithonia, GA 30058-8833 | 2020-09-22 |
| 1033723150 | Grant Pheil | Specialist/Technologist | 3523 Old Penia Rd, Cordele, GA 31015-7714 | 2020-09-04 |
| 1376157933 | Jesus E Aviles | Specialist/Technologist | 755 Battery Ave Se, Atlanta, GA 30339-3017 | 2020-09-01 |
| 1588276943 | Jaden T Harris | Specialist/Technologist | 2205 Moncrieff St, Augusta, GA 30906-8905 | 2020-08-18 |
| 1891306437 | Tinasia Smalls | Specialist/Technologist | 100 Woodland Dr Apt 1416, Statesboro, GA 30458-6365 | 2020-08-16 |
| 1407467590 | Samantha Jean Libby | Specialist/Technologist | 2550 Akers Mill Rd Se Apt F14, Atlanta, GA 30339-3271 | 2020-08-12 |
| 1083224224 | John Christopher Hamil | Specialist/Technologist | 812 S Park St Ste 1, Carrollton, GA 30117-4412 | 2020-08-03 |
| 1780294926 | Andrew Alcantar | Specialist/Technologist | 7340 Fairmount Hwy Se, Calhoun, GA 30701-4023 | 2020-08-03 |
| Find all providers with the same taxonomy | ||||
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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.