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General NPI Number Information
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NPI Number | 1245427178
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Entity Type | Individual
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Provider Name | JUAN CARLOS LACAYO M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 3525 HIGHWAY 81
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City | LOGANVILLE
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State | GA
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Zip | 30052-4336
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Country | US
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Telephone | 678-905-9625
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Fax | 770-674-5880
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Provider Business Mailing Address
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Address Line | 3525 HIGHWAY 81
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City | LOGANVILLE
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State | GA
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Zip | 30052-4336
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Country | US
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Telephone | 678-905-9625
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Fax | 770-674-5880
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME101028
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 65835
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License Number State | GA
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