MEDICARE: LACYCASEMANAGEMENT INC

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
1	251B00000X	Case Management Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346951969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LACYCASEMANAGEMENT INC

Provider Business Mailing Address
First Line	:	1420 FOXHALL LN SE APT 8
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-3474
Country	:	US
Telephone Number	:	404-213-8517
Fax Number	:	404-328-0999

Provider Business Practice Location Address
First Line	:	1420 FOXHALL LN SE APT 8
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-3474
Country	:	US
Telephone Number	:	404-213-8517
Fax Number	:	404-328-0999

Authorized Official
Title or Position	:	CEO
Name	:	MS. CAROLYN ROGERS LACY
Credential	:	N/A
Telephone Number	:	404-213-8517

Provider Enumeration Date	:	12/06/2022
Last Update Date	:	12/06/2022

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Directions to “LACYCASEMANAGEMENT INC ” Practice Location

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