MRS. TRACIE THERESA EDWARDS


Address: 1412 Milstead Ave Ne, Conyers, GA 30012-3877
Phone: 7709183000

MRS. TRACIE THERESA EDWARDS (NPI# 1104486711) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1104486711
Entity Type Individual
Full Name MRS. TRACIE THERESA EDWARDS
Credential NP
Practice Address 1412 Milstead Ave Ne
Conyers
GA 30012-3877
Mailing Address 200 Corporate Blvd
Lafayette
LA 70508-3870
Practice Telephone 7709183000
Practice Fax Number 7709183104
Mailing Telephone 8008939698
Enumeration Date 2019-06-17
Last Update Date 2019-11-01
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363L00000X Nurse Practitioner RN288766 GA Physician Assistants & Advanced Practice Nursing Providers

Other Providers TRACIE EDWARDS

NPI Name Taxonomy Address Enumeration
1134384357 Tracie Dawn Edwards Hearing Instrument Specialist 7760 Route 417 W, Bolivar, NY 14715 2008-07-28
1669084760 Tracie Susan Edwards Technician 4550 W Oakey Blvd Ste 101a, Las Vegas, NV 89102-1506 2020-08-19
1215439617 Tracie L Edwards Case Manager/Care Coordinator 2500 John Glenn Hwy, Cambridge, OH 43725-9028 2018-03-02
1821248865 Tracie R Edwards Counselor 1110 Eldon Baker Dr, Flint, MI 48507-1923 2008-09-26

Office Location

Street Address 1412 MILSTEAD AVE NE
City CONYERS
State GA
Zip Code 30012-3877

Providers in the same location

NPI Name Taxonomy Address Enumeration
1033191093 Clifford N Grossman Radiology 1412 Milstead Ave Ne, Conyers, GA 30012-3877 2005-11-16
1417570102 Jonathan Stott Registered Nurse 1412 Milstead Ave Ne, Conyers, GA 30012-3877 2020-05-28
1386116309 Walker Lake Intensivist, PC Physician Assistant 1412 Milstead Ave Ne, Conyers, GA 30012-3877 2019-01-02
1437629342 Walker Lake Emergency Group, PC Physician Assistant 1412 Milstead Ave Ne, Conyers, GA 30012-3877 2018-12-04
1003385964 Walker Lake Physician Services, PC Internal Medicine 1412 Milstead Ave Ne, Conyers, GA 30012-3877 2018-11-20
1104328095 Enas Basha Nurse Practitioner 1412 Milstead Ave Ne, Conyers, GA 30012-3877 2018-03-06
1306355680 Piedmont Rockdale Hospital Inc. General Acute Care Hospital 1412 Milstead Ave Ne, Conyers, GA 30012 2017-09-29
1093254658 Taylor Zahn Yengst Nurse Practitioner 1412 Milstead Ave Ne, Conyers, GA 30012-3877 2017-02-15
1285186452 Shadae Mcmillan Podiatrist 1412 Milstead Ave Ne, Conyers, GA 30012-3877 2016-11-03
1528414943 Kimberly Anderson Nurse Practitioner 1412 Milstead Ave Ne, Conyers, GA 30012-3877 2016-05-05
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1578188306 The Eye Md Ophthalmology 1359 Milstead Road, Suite #103, Conyers, GA 30012 2020-06-08
1043855836 Maurvet Minto Counselor 1175 Green St, Conyers, Conyers, GA 30012 2019-11-15
1770054561 Sarah Elizabeth Brooks Physical Medicine & Rehabilitation 1290 Milstead Ave Ne, Conyers, GA 30012 2018-12-06
1679091276 Valorie Antoinette Jones Counselor 1175 Green St Se, Conyers, GA 30012 2017-09-02
1558886341 Synergy Radiology, LLC Radiology 1501 Milstead Road, Suite 140, Conyers, GA 30012 2017-08-14
1558813295 Salon Lyon, LLC Specialist 1112 West Ave, Se, B, Conyers, GA 30012 2016-10-28
1992252753 Traci Hunter Bryan Pharmacist 1501 Milstead Ave Ne, Suite 110, Conyers, GA 30012 2016-09-08
1316491830 Hye Rim Kim Anesthesiologist Assistant 1380 Milstead Rd Ne, Suite G, Conyers, GA 30012 2016-08-12
1235591397 David Jeffrey Wasserman Optometrist 1192 Dogwood Dr Sw, Conyers, GA 30012 2016-03-28
1174919187 Anique Archer Health Educator 2170 Lester Rd Nw, Conyers, GA 30012 2015-04-07
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Taxonomy Information

Taxonomy Code 363L00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner

Taxonomy Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1104438530 Mwiche Williams Nurse Practitioner 2337 Deerfield Chase Se, Conyers, GA 30013-6307 2020-08-18
1144790973 Marlyn M. Wallace Nurse Practitioner 3073 Klondike Rd Sw, Conyers, GA 30094-5660 2018-12-05
1174979587 Taaliba Al-alim Sahib Jr. Nurse Practitioner 511 Greenleaf Rd, Conyers, GA 30013-2274 2016-05-05
1679962534 Rose Gayle-smith Nurse Practitioner 2081 Millstone Dr Sw, Conyers, GA 30094-3981 2015-01-15
1124363577 Terri Tonisha Van Dorn Nurse Practitioner 1901 Honey Creek Commons Se, Conyers, GA 30013-5806 2012-12-11
1700908688 Angela L. Bright Nurse Practitioner 1157 West Ave Sw # B, Conyers, GA 30012-5280 2007-04-04
1881259703 Desiree Riley Nurse Practitioner 1388 Wellbrook Cir Ne Ste A, Conyers, GA 30012-3872 2019-05-06
1528550068 Chinyere Chigbu Nurse Practitioner 1501 Milstead Rd Ne Ste 110, Conyers, GA 30012-3849 2018-05-31
1093254658 Taylor Zahn Yengst Nurse Practitioner 1412 Milstead Ave Ne, Conyers, GA 30012-3877 2017-02-15
1528414943 Kimberly Anderson Nurse Practitioner 1412 Milstead Ave Ne, Conyers, GA 30012-3877 2016-05-05
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Competitor

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City CONYERS
Zip Code 30012

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Dataset Information

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.

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