LACEY BROOKE JOHNSON (NPI# 1649763236) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649763236 |
| Entity Type | Individual |
| Full Name | LACEY BROOKE JOHNSON |
| Credential | DO |
| Practice Address |
304 Shorter Ave Nw Ste 201 Rome GA 30165-4256 |
| Practice Telephone | 7065093358 |
| Practice Fax Number | 7062927653 |
| Mailing Telephone | 7065093358 |
| Mailing Fax Number | 7062927653 |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2018-06-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710418082 | Lacey Johnson | Counselor | 3655 Armington Rd, Palmyra, NY 14522-9607 | 2017-03-27 |
| 1730531559 | Lacey Johnson Jr. | Case Manager/Care Coordinator | 1335 N Cheyenne Ave, Tulsa, OK 74106-4623 | 2016-07-05 |
| 1538520994 | Lacey Johnson | Developmental Therapist | 257 Glimer Miller Road, Lowgap, NC 27024 | 2016-03-14 |
| 1952813230 | Lacey Johnson | Counselor | 1715 26th St, Lubbock, TX 79411-1524 | 2017-10-26 |
| 1861832404 | Lacey A Johnson | Nurse Practitioner | 440 Hopkinsville St, Greenville, KY 42345-1124 | 2013-06-27 |
| 1265757173 | Lacey Tilsen Johnson | Counselor | 368 Fell St, San Francisco, CA 94102-5144 | 2010-04-02 |
| 1366587180 | Lacey Anne Johnson | Marriage & Family Therapist | Ucsb, Building 588, Santa Barbara, CA 93106-7002 | 2007-02-20 |
| 1770684995 | Lacey Brooke Johnson | Occupational Therapist | 1501 E Greenville St, Anderson, SC 29621-2004 | 2006-09-26 |
| Street Address |
304 SHORTER AVE NW STE 201 |
| City | ROME |
| State | GA |
| Zip Code | 30165-4256 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154327856 | Johnathan Edward Henderson | Family Medicine | 304 Shorter Ave Nw Ste 201, Rome, GA 30165 | 2005-06-27 |
| 1568087708 | Nzota Pelagie Nsona Koyagialo | Student in an Organized Health Care Education/Training Program | 304 Shorter Ave Nw Ste 201, Rome, GA 30165-4256 | 2020-06-13 |
| 1912562927 | Romy Bhagat | Student in an Organized Health Care Education/Training Program | 304 Shorter Ave Nw Ste 201, Rome, GA 30165-4256 | 2019-05-06 |
| 1710542725 | Ashley Corey | Student in an Organized Health Care Education/Training Program | 304 Shorter Ave Nw Ste 201, Rome, GA 30165-4256 | 2019-05-06 |
| 1811552821 | Trever Biles | Student in an Organized Health Care Education/Training Program | 304 Shorter Ave Nw Ste 201, Rome, GA 30165-4256 | 2019-05-06 |
| 1588229595 | Benjamin Steven Bell | Student in an Organized Health Care Education/Training Program | 304 Shorter Ave Nw Ste 201, Rome, GA 30165-4256 | 2019-05-06 |
| 1528623535 | Diego Herrera | Student in an Organized Health Care Education/Training Program | 304 Shorter Ave Nw Ste 201, Rome, GA 30165-4256 | 2019-05-06 |
| 1871158881 | Ra'shead Pompey | Student in an Organized Health Care Education/Training Program | 304 Shorter Ave Nw Ste 201, Rome, GA 30165-4256 | 2019-05-06 |
| 1780249706 | Logan Minshew | Student in an Organized Health Care Education/Training Program | 304 Shorter Ave Nw Ste 201, Rome, GA 30165-4256 | 2019-05-06 |
| 1871158840 | Jordan Moss | Student in an Organized Health Care Education/Training Program | 304 Shorter Ave Nw Ste 201, Rome, GA 30165-4256 | 2019-05-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346868775 | Heather Bowman | Physical Therapist | 600 Eagle, E Lake Dr, Rome, GA 30165 | 2020-07-13 |
| 1205451101 | Kristopher Nelson | Student in an Organized Health Care Education/Training Program | 4256, 304 Shorter Ave Nw #201, Rome, GA 30165 | 2020-06-16 |
| 1962061457 | Stuart Paul Shaklee | Occupational Therapy Assistant | 1356 Redmond Road, Rome, GA 30165 | 2019-06-10 |
| 1386001055 | Autumn Streetman | Counselor | 6 Mathis Drive, Rome, GA 30165 | 2016-01-26 |
| 1144695784 | Gabrador Milligan | Counselor | 6 Mathis Road, Rome, GA 30165 | 2015-12-08 |
| 1386041952 | Theresa Suits | Registered Nurse | 1 Woodbine Avenue, Rome, GA 30165 | 2014-11-26 |
| 1942561147 | Nicole C. Christian | Clinical Neuropsychologist | 305 Redmond Rd, Rome, GA 30165 | 2012-06-04 |
| 1679832711 | Niki Pareshkumar Bhavsar | Internal Medicine | 3041 Turner Mccall Blvd, Rome, GA 30165 | 2012-05-10 |
| 1285927491 | Amanda Fischer Reeves | Family Medicine | 304 Shorter Ave Nw Ste 102, Rome, GA 30165 | 2011-05-20 |
| 1033436647 | Northland Hearing Centers, Inc. | Hearing Instrument Specialist | 4 Coosawattee Ave, Rome, GA 30165 | 2010-04-23 |
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| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205451101 | Kristopher Nelson | Student in an Organized Health Care Education/Training Program | 4256, 304 Shorter Ave Nw #201, Rome, GA 30165 | 2020-06-16 |
| 1659877579 | Jessica Judith White | Student in an Organized Health Care Education/Training Program | 101 Lovell Ln Sw, Rome, GA 30165-3631 | 2018-03-30 |
| 1497370506 | Nathan Henry | Student in an Organized Health Care Education/Training Program | 304 Turner Mccall Blvd Sw, Rome, GA 30165-5621 | 2020-06-15 |
| 1124643291 | Gokhan Emre Taskale | Student in an Organized Health Care Education/Training Program | 304 Turner Mccall Blvd Sw, Rome, GA 30165-5621 | 2020-06-14 |
| 1962027037 | Adriana Delmonico | Student in an Organized Health Care Education/Training Program | 304 Turner Mccall Blvd Sw, Rome, GA 30165-5621 | 2020-06-14 |
| 1568087708 | Nzota Pelagie Nsona Koyagialo | Student in an Organized Health Care Education/Training Program | 304 Shorter Ave Nw Ste 201, Rome, GA 30165-4256 | 2020-06-13 |
| 1295350494 | Edward Lawson Held | Student in an Organized Health Care Education/Training Program | 304 Turner Mccall Blvd Sw, Rome, GA 30165-5621 | 2020-06-12 |
| 1740805951 | Yassmin Shariff | Student in an Organized Health Care Education/Training Program | 304 Turner Mccall Blvd Sw, Rome, GA 30165-5621 | 2020-06-12 |
| 1982229175 | Gregory Rusiecki | Student in an Organized Health Care Education/Training Program | 304 Turner Mccall Blvd Sw, Rome, GA 30165-5621 | 2020-06-12 |
| 1932738127 | Anand Marangattu Parameswaran | Student in an Organized Health Care Education/Training Program | 501 Redmond Road, Rome, GA 30165 | 2020-04-08 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.