| Rachael Clark Lackey, ARNP | |
|
4681 Us Highway 84 Byp W, Thomasville, GA 31792-2607 | |
| (229) 227-2936 | |
| (229) 226-2036 |
| Full Name | Rachael Clark Lackey |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner - Family |
| Location | 4681 Us Highway 84 Byp W, Thomasville, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780922849 | NPI | - | NPPES |
| ARNP9297951 | Other | FL | FLORIDA DEPARTMENT OF HEALTH |
| RN224594 | Other | GA | GA LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LP0200X | Nurse Practitioner - Pediatrics | ARNP9297951 (Florida) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | RN224594 (Georgia) | Primary |
| Entity Name | Primary Care Of Southwest Georgia, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1366641318 PECOS PAC ID: 5496777948 Enrollment ID: O20060201000362 |
| Mailing Address | Practice Location Address |
|---|---|
| Rachael Clark Lackey, ARNP 454 Smith Ave, Thomasville, GA 31792-5535 Ph: (229) 584-2540 | Rachael Clark Lackey, ARNP 4681 Us Highway 84 Byp W, Thomasville, GA 31792-2607 Ph: (229) 227-2936 |
Mrs. Melanie Jai Balfour, ARNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 100 S Madison St, Thomasville, GA 31792 Phone: 229-236-0831 Fax: 229-236-0871 | |
Mrs. Courtnay Kelly Perryman, PMHNP-BC Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1102 Smith Ave Ste K, Thomasville, GA 31792 Phone: 229-225-4335 | |
Ms. Allen R Lybrook, APRN,BC Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 116 Mimosa Dr, Thomasville, GA 31792 Phone: 229-226-5788 Fax: 229-226-2548 | |
Mrs. Patrice Gunter Bullock, MSN, APRN-C Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 115 Circle Dr, Thomasville, GA 31792 Phone: 229-225-9830 | |
Mary Racheal Havens, ARNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 454 Smith Ave, Thomasville, GA 31792 Phone: 229-227-5510 | |
Kristin F Deutsch, N.P. Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 112 Mimosa Dr, Thomasville, GA 31792 Phone: 229-227-0045 Fax: 229-227-9120 | |
Cecilie Cowie, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 900 Gordon Ave, Thomasville, GA 31792 Phone: 229-226-0125 Fax: 229-226-0195 |