Individual
MARY LACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
350 HOSPITAL DR, MACON, GA 99508-4615
(478) 765-4132
Mailing address
350 HOSPITAL DR, MACON, GA 99519-6276
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
RN182787
GA
363LP0222X
Critical Care Pediatric Nurse Practitioner
794
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP0794
—
AK
05
—
RN182787
—
GA
Enumeration date
07/31/2007
Last updated
04/11/2014
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