TRACI MCLIN (NPI# 1619443090) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619443090 |
| Entity Type | Individual |
| Full Name | TRACI MCLIN |
| Practice Address |
10203 Lucas Ferry Rd Ste B Tanner AL 35671-3406 |
| Mailing Address |
25898 Iron Gate Dr Madison AL 35756-3041 |
| Practice Telephone | 2562330202 |
| Mailing Telephone | 2562330202 |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2018-10-23 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1744P3200X |
Specialist Specialization: Prosthetics Case Management |
Other Service Providers |
| Street Address |
10203 LUCAS FERRY RD STE B |
| City | TANNER |
| State | AL |
| Zip Code | 35671-3406 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447423009 | Stanley Farrell Smallwood | Nurse Practitioner | 20104 Swanner Blvd, Suite 4, Tanner, AL 35671 | 2008-04-03 |
| 1467098681 | Fhl Group Home,llc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 12218 Spring Rd, Tanner, AL 35671-3214 | 2019-11-22 |
| 1588690481 | Tracy L Pool | Emergency Medicine | 20250 Capitol Hill Dr, Tanner, AL 35671-3638 | 2006-06-23 |
| 1801135538 | Meredith Clark Belew | Nurse Practitioner | 20104 Swanner Blvd, Suite 4, Tanner, AL 35671-3651 | 2013-01-31 |
| 1376881870 | Tanner Medical Clinic LLC | Family Medicine | 20104 Swanner Blvd, Suite 4, Tanner, AL 35671-3651 | 2013-01-18 |
| 1366555013 | Tammy V Garrett | Pharmacist | 11964 Escue Dr Ste A, Tanner, AL 35671-3680 | 2006-08-16 |
| 1992280366 | Tammy V Garrett | Pharmacist | 11964 Escue Dr Ste A, Tanner, AL 35671-3680 | 2018-10-01 |
| 1548544752 | Southside Pharmacy Inc | Pharmacy | 11964 Escue Dr Ste A, Tanner, AL 35671-3680 | 2011-10-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467098681 | Fhl Group Home,llc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 12218 Spring Rd, Tanner, AL 35671-3214 | 2019-11-22 |
| 1447423009 | Stanley Farrell Smallwood | Nurse Practitioner | 20104 Swanner Blvd, Suite 4, Tanner, AL 35671 | 2008-04-03 |
| 1366555013 | Tammy V Garrett | Pharmacist | 11964 Escue Dr Ste A, Tanner, AL 35671-3680 | 2006-08-16 |
| 1588690481 | Tracy L Pool | Emergency Medicine | 20250 Capitol Hill Dr, Tanner, AL 35671-3638 | 2006-06-23 |
| 1992280366 | Tammy V Garrett | Pharmacist | 11964 Escue Dr Ste A, Tanner, AL 35671-3680 | 2018-10-01 |
| 1801135538 | Meredith Clark Belew | Nurse Practitioner | 20104 Swanner Blvd, Suite 4, Tanner, AL 35671-3651 | 2013-01-31 |
| 1376881870 | Tanner Medical Clinic LLC | Family Medicine | 20104 Swanner Blvd, Suite 4, Tanner, AL 35671-3651 | 2013-01-18 |
| 1548544752 | Southside Pharmacy Inc | Pharmacy | 11964 Escue Dr Ste A, Tanner, AL 35671-3680 | 2011-10-06 |
| Taxonomy Code | 1744P3200X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| Specialization | Prosthetics Case Management |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124665575 | Trinity Styles | Specialist | 3725 Airport Blvd Ste 106, Mobile, AL 36608-1637 | 2019-12-04 |
| 1669018511 | Stephanie Culpepper Stubbs | Specialist | 29461 Highway 43, Thomasville, AL 36784-5737 | 2019-11-25 |
| 1003467465 | Ruthie L Bush | Specialist | 8 Bosby Ln, Fairhope, AL 36532-1756 | 2019-09-26 |
| 1174181309 | Brionna Brooks | Specialist | 1420 Paramount Dr Ste G, Huntsville, AL 35806-2834 | 2019-06-03 |
| 1881259166 | Kimberly Jones | Specialist | 69 N Burbank Dr, Montgomery, AL 36117-5303 | 2019-05-02 |
| 1811550932 | Paula Eveyette Jones | Specialist | 729 Lakeside Dr W, Mobile, AL 36693-5125 | 2019-04-15 |
| 1497212070 | Juakeshia Smith Bates | Specialist | 706 Forest Avenue, Montgomery, AL 36106-1005 | 2019-03-01 |
| 1245795632 | Tara Jean Mcadams-may | Specialist | 1861 Old Government St, Mobile, AL 36606-1344 | 2019-02-10 |
| 1477018117 | Andread Mayers I | Specialist | 11123 Chantilly Pkwy Ct Unit K, Pike Road, AL 36064-2881 | 2019-02-06 |
| 1417421496 | Tiffany Webb | Specialist | 411 Twain Curve, E, Montgomey, AL 36117 | 2019-01-14 |
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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.