Healthcare Provider Details

I. General information

NPI: 1770405961
Provider Name (Legal Business Name): LUCAS DALTON BRIANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 UNIVERSITY BLVD
BIRMINGHAM AL
35233-1815
US

IV. Provider business mailing address

3500 CLAIRMONT AVE S APT 108
BIRMINGHAM AL
35222-3518
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-5428
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-184338
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: