Provider Demographics
NPI:1770921405
Name:DR LACY A. COLSON, MD
Entity type:Organization
Organization Name:DR LACY A. COLSON, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LACY
Authorized Official - Middle Name:ALSTON
Authorized Official - Last Name:COLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-231-6073
Mailing Address - Street 1:123 SUNNYBROOK RD. STE 120
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610
Mailing Address - Country:US
Mailing Address - Phone:919-231-6073
Mailing Address - Fax:919-231-8093
Practice Address - Street 1:123 SUNNYBROOK RD
Practice Address - Street 2:STE 120
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610
Practice Address - Country:US
Practice Address - Phone:919-231-6073
Practice Address - Fax:919-231-8093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18360207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty