Provider Demographics
NPI:1598175614
Name:LUCAS, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
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 1:1641 NEW HIGH SHOALS RD
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-5332
Mailing Address - Country:US
Mailing Address - Phone:706-310-4185
Mailing Address - Fax:
Practice Address - Street 1:1641 NEW HIGH SHOALS RD
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-5332
Practice Address - Country:US
Practice Address - Phone:706-310-4185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies