Healthcare Provider Details

I. General information

NPI: 1407597701
Provider Name (Legal Business Name): OLGA LACKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2174 N DRUID HILLS RD NE
ATLANTA GA
30329-3102
US

IV. Provider business mailing address

705 RILEY HOSPITAL DR., RI-5837
INDIANAPOLIS IN
46202
US

V. Phone/Fax

Practice location:
  • Phone: 412-610-6233
  • Fax:
Mailing address:
  • Phone: 317-944-4034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number105046
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: