Physician Compare National (NPI:1447568308)

HEALTHCARE PROVIDER: CHARLEANE CHANTELL LACROIX CNM

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1447568308
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8921276163
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170329000957
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	LACROIX
	Individual professional last name
Provider First Name	CHARLEANE
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2010
	Individual professional's medical school graduation year
Primary Specialty	CERTIFIED NURSE MIDWIFE (CNM)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	WELLSTAR MEDICAL GROUP, LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	6709065402
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	1366
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1700 HOSPITAL S DR
	Group Practice or individual's line 1 address
Marker of address line 2 suppression	Y
	Marker that address as reported may be incomplete
City	AUSTELL
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	301068159
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y