Provider Demographics
NPI:1750447561
Name:MCCARTNEY, LUCIANN M (MS, PT)
Entity type:Individual
Prefix:MRS
First Name:LUCIANN
Middle Name:M
Last Name:MCCARTNEY
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RETREAT RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-1837
Mailing Address - Country:US
Mailing Address - Phone:706-306-3800
Mailing Address - Fax:706-738-8513
Practice Address - Street 1:814 DOGWOOD LN
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2704
Practice Address - Country:US
Practice Address - Phone:706-306-3800
Practice Address - Fax:706-738-2717
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT 003850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52440160OtherBCBS OF GEORGIA
GA000606273FMedicaid
GA3339653OtherWELLCARE OF GEORGIA
GA10036237OtherAMERIGROUP OF GEORGIA