Provider Demographics
NPI:1083650980
Name:DR MICHAEL LACEY MD P.C
Entity type:Organization
Organization Name:DR MICHAEL LACEY MD P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:H
Authorized Official - Last Name:DISSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-252-2666
Mailing Address - Street 1:5887 GLENRIDGE DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:404-252-2666
Mailing Address - Fax:404-252-0890
Practice Address - Street 1:5887 GLENRIDGE DRIVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:404-252-2666
Practice Address - Fax:404-252-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA13BDDDJOtherFRESCHI MEDICARE ID
GA231926531Medicare ID - Type UnspecifiedLACEY MEDICARE PROVIDER #
GA13BDDDJOtherFRESCHI MEDICARE ID
GAD29502Medicare UPIN
GAD40391Medicare UPIN