Provider Demographics
NPI:1225083926
Name:LUCAS, ANN T
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:T
Last Name:LUCAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2357
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31799-2357
Mailing Address - Country:US
Mailing Address - Phone:229-226-8800
Mailing Address - Fax:229-226-8232
Practice Address - Street 1:918 SOUTH BROAD ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31799-0918
Practice Address - Country:US
Practice Address - Phone:229-226-8800
Practice Address - Fax:229-226-8232
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY0001503103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBDQBMedicare ID - Type Unspecified
NPP000Medicare UPIN