Individual
THELMA E WILEY-LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
157 CLINIC AVE STE 201, CARROLLTON, GA 30117-4454
(770) 214-2800
(770) 214-2803
Mailing address
157 CLINIC AVE STE 201, CARROLLTON, GA 30117-4454
(770) 214-2800
(770) 214-2803
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
058487
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179173719A
—
GA
01
—
P00384988
RAIL ROAD MEDICARE
GA
Enumeration date
06/25/2006
Last updated
06/10/2025
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