Individual
LACEY GOLDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
48 MEDICAL PARK DR E STE 255, BIRMINGHAM, AL 35235-3464
(205) 838-3090
(205) 838-3043
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA.638
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04957385
—
MS
01
—
051114784
BCBS
AL
01
—
051114785
BCBS
AL
01
—
051114787
BCBS
AL
05
—
127143
—
AL
05
—
127144
—
AL
Enumeration date
12/13/2010
Last updated
01/21/2019
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