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General NPI Number Information
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NPI Number | 1023518529
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Entity Type | Individual
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Provider Name | LACEY NICOLE CORNELIUS DO
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Gender | Female
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Dates
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Enumeration Date | 02/20/2018
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 101 SIVLEY RD SW
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City | HUNTSVILLE
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State | AL
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Zip | 35801-4421
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Country | US
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Telephone | 256-265-3880
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 21007
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City | HUNTSVILLE
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State | AL
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Zip | 35813-5007
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Country | US
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Telephone | 256-801-6047
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Fax | 256-801-6218
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2577
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | DO.2577
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License Number State | AL
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