Provider Demographics
NPI:1346531662
Name:LUCAS, MANDY KATRICE (MD)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:KATRICE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 0070
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-0070
Mailing Address - Country:US
Mailing Address - Phone:229-433-8741
Mailing Address - Fax:229-433-8742
Practice Address - Street 1:1221 E. MCPHERSON AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:NASHVILLE
Practice Address - State:GA
Practice Address - Zip Code:31939-2326
Practice Address - Country:US
Practice Address - Phone:229-433-8741
Practice Address - Fax:229-433-8742
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA072347207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine