Provider Demographics
NPI:1427771047
Name:O'NEAL, LACY O'SHEA (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LACY
Middle Name:O'SHEA
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LACY
Other - Middle Name:O'SHEA
Other - Last Name:PETRIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1071
Mailing Address - Country:US
Mailing Address - Phone:678-288-9555
Mailing Address - Fax:678-288-9556
Practice Address - Street 1:101 RIVERSTONE VIS STE 102
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-6630
Practice Address - Country:US
Practice Address - Phone:706-258-4140
Practice Address - Fax:706-258-4141
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP000987363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily