Healthcare Provider Details

I. General information

NPI: 1871577130
Provider Name (Legal Business Name): GEORGIA LAY A.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 OLD HIGHWAY 280
CHELSEA AL
35043-3000
US

IV. Provider business mailing address

11600 OLD HIGHWAY 280
CHELSEA AL
35043-3000
US

V. Phone/Fax

Practice location:
  • Phone: 205-678-8755
  • Fax: 888-611-8229
Mailing address:
  • Phone: 205-678-8755
  • Fax: 888-611-8229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number7531
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: