Healthcare Provider Details

I. General information

NPI: 1881658177
Provider Name (Legal Business Name): CYNTHIA D LUCAS RNCWHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 COLISEUM PL
MACON GA
31217-3867
US

IV. Provider business mailing address

650 COLISEUM PL
MACON GA
31217-3867
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-7935
  • Fax: 478-745-7806
Mailing address:
  • Phone: 478-745-7935
  • Fax: 478-745-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberR125151
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: