Individual provider Active NPI

James Dylan Lackey, FNP-BC

  • Family Nurse Practitioner
  • Atlanta, GA
National Provider Identifier
1205403151
Registry record updated May 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN282621 Issued in GA
Practice address
1438 W Peachtree St NW
Atlanta, GA 30309-2998
Phone
(470) 283-7349
Fax
(833) 689-2507
NPI assigned
Jun 9, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN282621 GA Primary

Addresses

Primary practice location

1438 W Peachtree St NW
Atlanta, GA 30309-2998

Mailing address

6255 W Sunset Blvd FL 21
Los Angeles, CA 90028-7422
Phone (323) 860-5200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210909002101 GA Practitioner - Nurse Practitioner 9032515473 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of South Alabama College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
AIDS Healthcare FoundationGroup PAC ID 2668369109, 101 clinicians

Practice addresses (Care Compare)

1438 W Peachtree St NW
Atlanta, GA 30309-2998
Phone (470) 283-7349

Merit-based Incentive Payment System (MIPS)

Final score
82.5 of 100Reported as group
Quality
64.78
Improvement activities
40
Cost
79.23

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN282621GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Romulus Primary Care Services LLC CurrentSince Aug 1, 2021 Accepting new patients
AIDS Healthcare Foundation CurrentSince Dec 12, 2022 Accepting new patients
AIDS Healthcare Foundation CurrentSince Dec 12, 2022 Accepting new patients
Aid Atlanta Inc CurrentSince Apr 27, 2022 Accepting new patients
AIDS Healthcare Foundation Past Accepting new patients

Locations

6255 W Sunset Blvd
Fl 21
Los Angeles, CA 90028
Phone (323) 860-5200

1438 W Peachtree St NW
Atlanta, GA 30309
Phone (470) 283-7349

735 Piedmont Ave NE
Atlanta, GA 30308
Phone (404) 588-4680

4439 Austell Rd
Austell, GA 30106
Phone (770) 675-7407

4940 Governors Dr
Ste 209
Forest Park, GA 30297
Phone (404) 397-7029

5700 Hillandale Dr
Ste 100
Lithonia, GA 30058
Phone (770) 593-6684

770 Greison Trl
Ste H
Newnan, GA 30263
Phone (404) 870-7700

Interoperability endpoints

  • Direct secure messaging: james.lackey.1@26356.direct.athenahealth.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1205403151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6255 W SUNSET BLVD FL 21",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900287422",
            "telephone_number": "323-860-5200",
            "fax_number": "234-677-1193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1438 W PEACHTREE ST NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303092998",
            "telephone_number": "470-283-7349",
            "fax_number": "833-689-2507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACKEY",
        "first_name": "JAMES",
        "middle_name": "DYLAN",
        "name_prefix": "Mr.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-09",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN282621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.