Organization
A1 ACTIVE CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREW M LACY SR. (MEMBER)
(678) 230-7095
Entity
Organization
Contact information
Practice address
300 COLONIAL CENTER PARKWAY, SUITE 100, ROSWELL, GA 30076-4892
(678) 230-7095
(678) 601-1365
Mailing address
300 COLONIAL CENTER PARKWAY, SUITE 100, ROSWELL, GA 30076-4892
(678) 230-7095
(678) 601-1365
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
060-R--1609
GA
Other
Enumeration date
08/28/2016
Last updated
05/03/2017
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