MEDICARE: LACY AND COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305S00000X	Point of Service	066110LGB	GA

General Provider Information

NPI Number	:	1265593446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LACY AND COMPANY

Provider Business Mailing Address
First Line	:	1420 FOXHALL LANE #8
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-3474
Country	:	US
Telephone Number	:	404-328-0999
Fax Number	:	404-328-0999

Provider Business Practice Location Address
First Line	:	1420 FOXHALL LN SE APT 8
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-3474
Country	:	US
Telephone Number	:	404-328-0999
Fax Number	:	404-328-0999

Authorized Official
Title or Position	:	ICWP CASE MANAGER
Name	:	MS. CAROLYN LACY
Credential	:	CWM
Telephone Number	:	404-328-0999

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	08/22/2020

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