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General NPI Number Information
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NPI Number | 1518382043
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Entity Type | Individual
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Provider Name | MELANIE ANN LACY CPNP-AC
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Gender | Female
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 07/09/2021
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Provider Practice Location Address
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Address Line | 993 JOHNSON FERRY RD STE F210
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City | ATLANTA
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State | GA
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Zip | 30342-1688
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Country | US
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Telephone | 404-256-1727
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Fax | 404-256-0192
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Provider Business Mailing Address
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Address Line | 993 JOHNSON FERRY RD STE F210
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City | ATLANTA
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State | GA
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Zip | 30342-1688
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Country | US
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Telephone | 404-256-1727
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Fax | 404-256-0192
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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 | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 18680
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LP0222X
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Taxonomy Name | Critical Care Pediatric Nurse Practitioner
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License Number | AP127143
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN191439
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License Number State | GA
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