Provider Demographics
NPI:1083650980
Name:DRS LACEY & FRESCHI, PC
Entity Type:Organization
Organization Name:DRS LACEY & FRESCHI, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:H
Authorized Official - Last Name:DISSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-252-2666
Mailing Address - Street 1:1100 JOHNSON FERRY RD NE
Mailing Address - Street 2:BUILDING 1, SUITE 425
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-252-2666
Mailing Address - Fax:404-252-0890
Practice Address - Street 1:1100 JOHNSON FERRY RD NE
Practice Address - Street 2:BLDG 1, SUITE 425
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-252-2666
Practice Address - Fax:404-252-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029704174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA13BDDDJOtherFRESCHI MEDICARE ID
GA231926531Medicare ID - Type UnspecifiedLACEY MEDICARE PROVIDER #
GA13BDDDJOtherFRESCHI MEDICARE ID
GAD29502Medicare UPIN
GAD40391Medicare UPIN