Individual provider · Type 1 NPI

Jacob Gray Lackey, PA-C

Physician Assistant · Clemmons, NC

NPI number 1699178731 Active

Practice location

3163 Gammon Ln
Clemmons, NC 27012-9052

Call (336) 310-5571 Map

Fax (336) 310-5574

Mailing address

PO Box 601843
Charlotte, NC 28260-1843

Specialties and licenses

Taxonomy	Code	License
Physician Assistant Primary	363A00000X	0010-05288 (NC)
Medical Physician Assistant	363AM0700X	001005288 (NC)

Physician Assistant: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, orde…

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About NPI 1699178731

Jacob Gray Lackey, PA-C's National Provider Identifier is 1699178731, issued on Oct 3, 2014. The primary taxonomy on file is Physician Assistant (363A00000X), and the practice location is in Clemmons, NC. The record was last updated on Aug 18, 2021.