Provider Demographics
NPI:1265593446
Name:LACY AND COMPANY
Entity type:Organization
Organization Name:LACY AND COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ICWP CASE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:CWM
Authorized Official - Phone:404-328-0999
Mailing Address - Street 1:1420 FOXHALL LANE #8
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-3474
Mailing Address - Country:US
Mailing Address - Phone:404-328-0999
Mailing Address - Fax:404-328-0999
Practice Address - Street 1:1420 FOXHALL LN SE APT 8
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-3474
Practice Address - Country:US
Practice Address - Phone:404-328-0999
Practice Address - Fax:404-328-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066110LGB305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service