Provider Demographics
NPI:1689430837
Name:ABRAMS, LACEY BRIANNA (NP)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:BRIANNA
Last Name:ABRAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 MULBERRY COVE WAY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30011-5600
Mailing Address - Country:US
Mailing Address - Phone:770-866-3533
Mailing Address - Fax:
Practice Address - Street 1:3520 MULBERRY COVE WAY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:GA
Practice Address - Zip Code:30011-5600
Practice Address - Country:US
Practice Address - Phone:770-866-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN290178363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics