Provider Demographics
NPI:1255732798
Name:LUCAS, MARY VIRGINIA GIRARDEAU (APRN, FNP-C, PMHNP)
Entity type:Individual
Prefix:
First Name:MARY VIRGINIA
Middle Name:GIRARDEAU
Last Name:LUCAS
Suffix:
Gender:F
Credentials:APRN, FNP-C, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 POWERS FERRY RD SE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2823
Mailing Address - Country:US
Mailing Address - Phone:678-801-2313
Mailing Address - Fax:844-249-2637
Practice Address - Street 1:401 WITSELL ST
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-3052
Practice Address - Country:US
Practice Address - Phone:843-549-5546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19050363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health