Provider Demographics
NPI:1528840436
Name:JUJARA, TRACY
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:
Last Name:JUJARA
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 1:3292 ERNEST W BARRETT PKWY NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1872
Mailing Address - Country:US
Mailing Address - Phone:470-531-5940
Mailing Address - Fax:
Practice Address - Street 1:3292 BARRETT PKWY NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1872
Practice Address - Country:US
Practice Address - Phone:470-531-5940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility