Provider Demographics
NPI:1538487939
Name:LACY, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:LACY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1928 ALCOA HWY STE B222
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1504
Mailing Address - Country:US
Mailing Address - Phone:865-305-9254
Mailing Address - Fax:865-305-4589
Practice Address - Street 1:1928 ALCOA HWY STE B222
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1504
Practice Address - Country:US
Practice Address - Phone:865-305-9254
Practice Address - Fax:865-305-4589
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2021-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN54136208800000X
KYR23142088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Yes208800000XAllopathic & Osteopathic PhysiciansUrology