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General NPI Number Information
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NPI Number | 1265593446
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Entity Type | Organization
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Legal Business Name | LACY AND COMPANY
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1420 FOXHALL LN SE APT 8
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City | ATLANTA
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State | GA
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Zip | 30316-3474
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Country | US
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Telephone | 404-328-0999
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Fax | 404-328-0999
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Provider Business Mailing Address
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Address Line | 1420 FOXHALL LANE #8
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City | ATLANTA
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State | GA
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Zip | 30316-3474
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Country | US
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Telephone | 404-328-0999
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Fax | 404-328-0999
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Authorized Official
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Title or Position | ICWP CASE MANAGER
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Name | MS. CAROLYN LACY
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Credential | CWM
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Telephone | 404-328-0999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 066110LGB
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License Number State | GA
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