Healthcare Provider Details

I. General information

NPI: 1891562930
Provider Name (Legal Business Name): LACY MCKAY ADAMSON WEST APC ATR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LACY MCKAY ADAMSON

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 WALL ST SE STE 240
CONYERS GA
30013-2296
US

IV. Provider business mailing address

757 SUGAR HILL LN SE
CONYERS GA
30094-3743
US

V. Phone/Fax

Practice location:
  • Phone: 470-829-6301
  • Fax:
Mailing address:
  • Phone: 404-313-9807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number008510
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number23-509
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: