Individual
LACY NICOLE TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2109 FAIRBURN RD STE A, DOUGLASVILLE, GA 30135-1037
(770) 726-7958
Mailing address
2500 SHADY GROVE RD, CARROLLTON, GA 30116-8186
(678) 733-1131
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN066474
GA
Other
Enumeration date
04/13/2018
Last updated
04/13/2018
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