Provider Demographics
NPI:1376990309
Name:LUCAS, STEVEN KYLE
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:KYLE
Last Name:LUCAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 APPLE ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-5925
Mailing Address - Country:US
Mailing Address - Phone:404-953-9335
Mailing Address - Fax:
Practice Address - Street 1:1880 BEAVER RIDGE CIR
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-3833
Practice Address - Country:US
Practice Address - Phone:404-953-9335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic