Healthcare Provider Details

I. General information

NPI: 1992290936
Provider Name (Legal Business Name): LUCAS ALLEN BRYANT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 EAST HOSPITAL ROAD
FORT GORDON GA
30905
US

IV. Provider business mailing address

300 EAST HOSPITAL ROAD
FORT GORDON GA
30905
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-5811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberU7391
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: