Healthcare Provider Details

I. General information

NPI: 1215399092
Provider Name (Legal Business Name): DR. LUCAS E WILMORE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 SE PARKWAY CT
FRANKLIN TN
37064-3968
US

IV. Provider business mailing address

854 W JAMES CAMPBELL BLVD, SUITE 303
COLUMBIA TN
38041
US

V. Phone/Fax

Practice location:
  • Phone: 615-790-0567
  • Fax:
Mailing address:
  • Phone: 931-540-4255
  • Fax: 931-490-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3763
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number101770796
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number3763
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: