Healthcare Provider Details

I. General information

NPI: 1891416079
Provider Name (Legal Business Name): KARIEF JANEEL LACROIX CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 OLD NORCROSS RD STE 200
LAWRENCEVILLE GA
30046-4308
US

IV. Provider business mailing address

2090 SOUTHERN WALK TER
DACULA GA
30019-2925
US

V. Phone/Fax

Practice location:
  • Phone: 770-338-1680
  • Fax:
Mailing address:
  • Phone: 404-822-9084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN209770
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: