Individual
JUSTIN TREVOR LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
ONE MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-3465
(336) 716-7246
(336) 716-8773
Mailing address
ONE MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-3465
(336) 716-7246
(336) 716-8773
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0101281117
VA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
317799
NC
Other
Enumeration date
03/30/2021
Last updated
10/03/2024
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