Individual
BETTY JANE LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
255 ENTERPRISE BLVD STE 101, GREENVILLE, SC 29615-3530
(864) 454-8120
(864) 454-8125
Mailing address
800 N FANT ST, ANDERSON, SC 29621-5708
(864) 512-1000
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
36751
SC
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
36751
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
367515
—
SC
01
—
NPI #
BLUE CHOICE
SC
01
—
P01624384
RR MEDICARE
SC
Enumeration date
06/23/2009
Last updated
08/08/2019
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