Individual
MAURICE EDWARDS-LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1514 VERNON RD, LAGRANGE, GA 30240-4131
(706) 691-9671
Mailing address
677 CHURCH ST NE, ATTN: GME, MARIETTA, GA 30060-1101
(706) 691-9671
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
87734
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/21/2018
Last updated
03/30/2021
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