Individual
LACEY ANTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1371 CHURCH STREET EXT NE STE 200, MARIETTA, GA 30060-7913
(678) 344-8900
Mailing address
1551 JANMAR RD, SNELLVILLE, GA 30078-5606
(678) 344-8900
(678) 666-5201
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
10187
GA
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
11/19/2020
Last updated
08/22/2023
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