Individual
MRS. LACIE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2415 MCCALLIE AVE, CHATTANOOGA, TN 37404-3322
(423) 624-2696
Mailing address
2415 MCCALLIE AVE, CHATTANOOGA, TN 37404-3322
(423) 624-2696
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
26228
TN
Other
Enumeration date
11/13/2019
Last updated
02/13/2020
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