Individual
DR. JAMES EDWIN LUCKIE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
182 PERRY HOUSE RD, SUITE E, FITZGERALD, GA 31750-8721
(229) 423-8725
(229) 423-8726
Mailing address
PO BOX 1349, FITZGERALD, GA 31750-1349
(229) 423-8725
(229) 423-8726
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19720
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000153821A
—
GA
01
—
581331734
TAX IDENTIFICATION NUMBER
GA
Enumeration date
08/09/2006
Last updated
08/26/2008
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