Provider Demographics
NPI:1922069129
Name:LUCAS, LORI JEAN (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:JEAN
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2208
Mailing Address - Country:US
Mailing Address - Phone:404-881-1094
Mailing Address - Fax:404-874-1249
Practice Address - Street 1:980 JOHNSON FERRY RD NE
Practice Address - Street 2:SUITE 820
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1626
Practice Address - Country:US
Practice Address - Phone:404-252-9307
Practice Address - Fax:404-252-5839
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2010-12-14
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Provider Licenses
StateLicense IDTaxonomies
GA27083207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB5609OtherRR MEDICARE
CB5609OtherRR MEDICARE
GAE99786Medicare UPIN