Provider Demographics
NPI:1871577130
Name:LAY, GEORGIA (ADS)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:LAY
Suffix:
Gender:F
Credentials:ADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 OLD HIGHWAY 280
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:AL
Mailing Address - Zip Code:35043-3000
Mailing Address - Country:US
Mailing Address - Phone:205-678-8755
Mailing Address - Fax:888-611-8229
Practice Address - Street 1:11600 OLD HIGHWAY 280
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:AL
Practice Address - Zip Code:35043-3000
Practice Address - Country:US
Practice Address - Phone:205-678-8755
Practice Address - Fax:888-611-8229
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7531171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102569Medicaid