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NPI Code Detail

MEDICARE: MS. ELIZABETH JANE LACKEY CPNP

MEDICARE: MS. ELIZABETH JANE LACKEY CPNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse PractitionerRN100203GA

General Provider Information

NPI Number : 1023280591
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELIZABETH JANE LACKEY CPNP
Provider Business Mailing Address
First Line : 2174 N DRUID HILLS RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30329-3102
Country : US
Telephone Number : 404-785-2897
Fax Number : 404-785-2611
Provider Business Practice Location Address
First Line : 2174 N DRUID HILLS RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30329-3102
Country : US
Telephone Number : 404-785-2897
Fax Number : 404-785-2611
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2008
Last Update Date : 11/06/2025

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