Individual
DR. JOHN ALBERT LUCAS IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2755 S HIGHWAY 14, SUITE 1200L, GREER, SC 29650-4902
(864) 849-9150
(864) 849-9334
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
36938
SC
207Q00000X
Family Medicine Physician
TL36938
SC
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
36938
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
369381
—
SC
01
—
SC36196067
MEDICARE PIN
SC
01
—
SC36196084
MEDICARE PIN
SC
01
—
SC36196121
MEDICARE PIN
SC
01
—
SC36197628
MEDICARE PIN
SC
01
—
SC3619J577
MEDICARE PIN
SC
Enumeration date
06/21/2010
Last updated
02/04/2021
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