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General NPI Number Information
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NPI Number | 1710627237
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Entity Type | Organization
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Legal Business Name | HARBOR INTERVENTIONAL PAIN CENTER, LLC
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Dates
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Enumeration Date | 03/31/2022
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Last Update Date | 03/31/2022
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Provider Practice Location Address
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Address Line | 4849 PAULSEN ST STE 312
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City | SAVANNAH
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State | GA
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Zip | 31405-4426
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Country | US
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Telephone | 413-218-1201
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Fax |
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Provider Business Mailing Address
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Address Line | 102 S TRAIL WAY # B9
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City | POOLER
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State | GA
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Zip | 31322-9815
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Country | US
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Telephone | 413-218-1201
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | DR. TIMOTHY LESTER LACY
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Credential | MD
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Telephone | 413-218-1201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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