Provider Demographics
NPI:1356607337
Name:LUCAS, SASHA BROOKE (DO)
Entity type:Individual
Prefix:DR
First Name:SASHA
Middle Name:BROOKE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S CHARLES G SEIVERS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716
Mailing Address - Country:US
Mailing Address - Phone:865-457-4702
Mailing Address - Fax:865-457-7178
Practice Address - Street 1:102 S CHARLES G SEIVERS BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716
Practice Address - Country:US
Practice Address - Phone:865-457-4702
Practice Address - Fax:865-457-7178
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000002800207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ013862Medicaid
TN10308I5624Medicare PIN