Individual
MRS. LINDA DIANNE LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
4905 FORSYTH RD, MACON, GA 31210-4401
(478) 471-1700
(478) 471-1222
Mailing address
4905 FORSYTH RD, MACON, GA 31210-4401
(478) 471-1700
(478) 471-1222
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN058252
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00370609B
—
GA
05
—
182875008A
—
GA
Enumeration date
03/30/2012
Last updated
03/30/2012
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