Marylou Lacomb-Davis, CPNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

RN250156 Issued in GA

Practice address

987 Saint Sebastian Way
Augusta, GA 30912-2613

Phone

(706) 721-9847

NPI assigned

Oct 8, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Au Nursing Associates, Inc.

  • Nurse Practitioner
  • Augusta, GA
  • NPI 1710194840
  Medicare reassignment NPD
• Au Medical Associates Inc

  • Durable Medical Equipment & Medical Supplies
  • Augusta, GA
  • NPI 1114574126
  NPD (past)
• Waldorf Pediatrics

  • Pediatrics Physician
  • White Plains, MD
  • NPI 1710237037
  NPD (past)

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

{
    "created_epoch": "1349654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611792000000",
    "number": "1881946374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "987 SAINT SEBASTIAN WAY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309122613",
            "telephone_number": "706-721-9847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "987 SAINT SEBASTIAN WAY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309122613",
            "telephone_number": "706-721-9847"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4255 Altamont Place",
            "address_2": "Suite 301",
            "address_purpose": "LOCATION",
            "city": "White Plains",
            "state": "MD",
            "postal_code": "20695",
            "country_code": "US",
            "telephone_number": "301-645-1781",
            "fax_number": "301-374-9237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LACOMB-DAVIS",
        "first_name": "MARYLOU",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-08",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MD",
            "license": "AC001077",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MD",
            "license": "R207282",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "DC",
            "license": "RN960827",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "VA",
            "license": "0024164874",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "GA",
            "license": "RN250156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathan B Labran
• David Lachance, D.O.
• Kevin Lack, P.A.-C
• Claire Lacksen
• Lacoles Transportation Services LLC
• Amber Ladak, PHARMD
• Derek Aaron Lafont, PA-C
• Lawrence James Lahatte, M.D.
• Brenton Carter Lake, PHARM.D.
• Cynthia Susan Lake

• Pediatric Nurse Practitioner in Augusta, GA
• Providers in Augusta, GA by specialty
• Pediatric Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.