Provider Demographics
NPI:1629006770
Name:LUCAS, AMY A (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:A
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3860
Mailing Address - Country:US
Mailing Address - Phone:864-725-4272
Mailing Address - Fax:864-725-4452
Practice Address - Street 1:1325 SPRING ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3860
Practice Address - Country:US
Practice Address - Phone:864-725-4272
Practice Address - Fax:864-725-4452
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC245121Medicaid
SC571020809009OtherBCBS SC
SC571020809004OtherTRICARE SC
SCGP1197Medicaid
SC571020809004OtherTRICARE SC
SC571020809009OtherBCBS SC
SCCI5810Medicare ID - Type UnspecifiedRR MEDICARE GROUP
SC4942Medicare ID - Type UnspecifiedGROUP IDENTIFIER