Individual
LACEY KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1364 CLIFTON RD NE, ATLANTA, GA 30322-1059
(404) 727-6123
Mailing address
1364 CLIFTON RD NE, ATLANTA, GA 30322-1059
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10284
GA
Other
Enumeration date
09/26/2019
Last updated
05/20/2021
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