Provider Demographics
NPI:1770515199
Name:LUCAS, ROBERTA WARD (MD)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:WARD
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:ANN
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:595 E CROSSVILLE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-5818
Mailing Address - Country:US
Mailing Address - Phone:770-645-2250
Mailing Address - Fax:770-643-5850
Practice Address - Street 1:595 E CROSSVILLE RD
Practice Address - Street 2:STE 100
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-5818
Practice Address - Country:US
Practice Address - Phone:770-645-2250
Practice Address - Fax:770-643-5850
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038040208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000580016EMedicaid