Provider Demographics
NPI:1811558737
Name:PERCY, LAKISHA
Entity Type:Individual
Prefix:MS
First Name:LAKISHA
Middle Name:
Last Name:PERCY
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 1:6925 GLEN ERROL WAY
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37412-4059
Mailing Address - Country:US
Mailing Address - Phone:423-718-5132
Mailing Address - Fax:
Practice Address - Street 1:6925 GLEN ERROL WAY
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37412-4059
Practice Address - Country:US
Practice Address - Phone:423-718-5132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN084741841172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty