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General NPI Number Information
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NPI Number | 1598049983
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Entity Type | Individual
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Provider Name | JAMES R LUCAS PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 03/31/2015
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Provider Practice Location Address
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Address Line | 111 W HOSPITAL DR
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-3405
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Country | US
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Telephone | 803-796-8515
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Fax | 803-796-8516
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Provider Business Mailing Address
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Address Line | 9735 KINCEY AVE SUITE 201
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-9118
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Country | US
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Telephone | 704-414-2870
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Fax | 704-414-2860
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MPA1695PA
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License Number State | SC
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