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General NPI Number Information
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NPI Number | 1912016742
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Entity Type | Individual
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Provider Name | JERRY ALLEN LUCAS MD
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 5354 REYNOLDS ST STE 315
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City | SAVANNAH
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State | GA
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Zip | 31405-6010
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Country | US
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Telephone | 912-354-2634
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Fax |
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Provider Business Mailing Address
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Address Line | 836 E 65TH ST STE 22
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City | SAVANNAH
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State | GA
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Zip | 31405-4493
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Country | US
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Telephone | 912-819-7171
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Fax | 912-691-9287
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 0101055788
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 90992
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License Number State | GA
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