Individual
LACEY NICOLE CORNELIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
101 SIVLEY RD SW, HUNTSVILLE, AL 35801-4421
(256) 265-3880
Mailing address
PO BOX 21007, HUNTSVILLE, AL 35813-5007
(256) 801-6047
(256) 801-6218
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2577
AL
208M00000X
Hospitalist Physician
Primary
DO.2577
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/20/2018
Last updated
08/13/2024
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