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General NPI Number Information
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NPI Number | 1215399092
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Entity Type | Individual
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Provider Name | DR. LUCAS E WILMORE
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Gender | Male
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 143 SE PARKWAY CT
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City | FRANKLIN
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State | TN
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Zip | 37064-3968
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Country | US
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Telephone | 615-790-0567
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Fax |
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Provider Business Mailing Address
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Address Line | 854 W JAMES CAMPBELL BLVD, SUITE 303
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City | COLUMBIA
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State | TN
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Zip | 38041
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Country | US
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Telephone | 931-540-4255
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Fax | 931-490-4654
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 3763
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 101770796
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 3763
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License Number State | TN
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