Individual
MR. BRIAN MITCHEL LACKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
991 WEST HUDSON BLVD, GASTONIA, NC 28052
(704) 853-5083
(704) 853-5240
Mailing address
991 WEST HUDSON BLVD, GASTONIA, NC 28052
(704) 853-5083
(704) 853-5240
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
138742
NC
Other
Enumeration date
10/02/2006
Last updated
07/08/2007
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