Organization
1ST SOURCE HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BRANDON LUCAS (ADMINISTRATOR)
(478) 972-0748
Entity
Organization
Contact information
Practice address
534 IVY BROOK WAY, MACON, GA 31210-4049
(478) 972-0748
Mailing address
534 IVY BROOK WAY, MACON, GA 31210-4049
(478) 972-0748
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
11/17/2015
Last updated
11/17/2015
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