Provider Demographics
NPI:1689757379
Name:ARMOUR ROAD FAMILY MEDICINE, PC
Entity Type:Organization
Organization Name:ARMOUR ROAD FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUCKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-320-9959
Mailing Address - Street 1:4820 ARMOUR ROAD
Mailing Address - Street 2:SUITE A-7
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904
Mailing Address - Country:US
Mailing Address - Phone:706-320-9959
Mailing Address - Fax:706-320-9950
Practice Address - Street 1:4820 ARMOUR ROAD
Practice Address - Street 2:SUITE A-7
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904
Practice Address - Country:US
Practice Address - Phone:706-320-9959
Practice Address - Fax:706-320-9950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAC24620Medicare UPIN
GA08BBVTPMedicare ID - Type Unspecified