Provider Demographics
NPI:1649551128
Name:HILLEY, TRACY NELSON (RPH)
Entity type:Individual
Prefix:MR
First Name:TRACY
Middle Name:NELSON
Last Name:HILLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 GREYSTONE TER
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-4469
Mailing Address - Country:US
Mailing Address - Phone:404-272-4864
Mailing Address - Fax:
Practice Address - Street 1:2100 N BROAD ST
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-1700
Practice Address - Country:US
Practice Address - Phone:706-336-5931
Practice Address - Fax:706-336-8092
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist