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Contact Information

JODI J LACKEY, MBA, MHA, MMSC, PA-C
4100 CARMEL RD
CHARLOTTE, NC28226-6150
 Phone: 864-288-8280
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Surgical

363AS0400X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for JODI J LACKEY · (Female)

NPI # 1568551729
Status Active
Credentials MBA, MHA, MMSC, PA-C
Entity Individual
Enumeration date 10/12/2006
Last updated 12/22/2021 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • GA License # 3097
  • NC License # 0010-01518
  • SC License # 1782
  • SC License # TL1782
  • SC Medicaid 0723PA
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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