Provider Demographics
NPI:1326744145
Name:TREACY, LINDSEY ROSE
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ROSE
Last Name:TREACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:336-248-4413
Mailing Address - Fax:336-248-6260
Practice Address - Street 1:106 W MEDICAL PARK DR STE A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-6854
Practice Address - Country:US
Practice Address - Phone:336-248-4413
Practice Address - Fax:336-248-6260
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA9198208600000X, 363A00000X
NC0010-13110208800000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208800000XAllopathic & Osteopathic PhysiciansUrology