Lacy, Mary J

Lacy, Mary J is an individual health care provider with primary practice located at 310 Kennestone Hospital Blvd , Marietta GA 30060-1120. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Lacy, Mary J can be contacted via phone (770) 793-7856.

Contact Information

Primary practice address
310 Kennestone Hospital Blvd Marietta GA 30060-1120
Phone: (770) 793-7856
Fax: (770) 793-7856
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X RN131464 Georgia

Profile Details

NPI number 1093701781
LBN Legal business name Lacy, Mary J
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 27th, 2005
Last updated Apr 17th, 2025 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093701781 NPPES
Georgia MEDICAID 962062906A
Georgia MEDICAID 962062906C

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