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General NPI Number Information
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NPI Number | 1659692952
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Entity Type | Individual
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Provider Name | JOHN ALBERT LUCAS IV M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2010
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Last Update Date | 02/04/2021
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Provider Practice Location Address
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Address Line | 2755 S HIGHWAY 14 SUITE 1200L
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City | GREER
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State | SC
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Zip | 29650-4902
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Country | US
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Telephone | 864-849-9150
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Fax | 864-849-9334
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Provider Business Mailing Address
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Address Line | PO BOX 743070
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City | ATLANTA
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State | GA
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Zip | 30374-3070
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Country | US
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Telephone | 864-560-4304
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Fax | 864-560-4413
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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 | 36938
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | TL36938
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License Number State | SC
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Taxonomy #3
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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 |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 36938
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License Number State | SC
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