Individual
DR. JERRY ALLEN LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5354 REYNOLDS ST STE 315, SAVANNAH, GA 31405-6010
(912) 354-2634
Mailing address
836 E 65TH ST STE 22, SAVANNAH, GA 31405-4493
(912) 819-7171
(912) 691-9287
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
0101055788
VA
207VX0000X
Obstetrics Physician
Primary
90992
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006210082
—
VA
01
—
160043283Q
RAILROAD MEDICARE ID#
VA
01
—
20507
VIRGINIA PREMIER ID #
VA
01
—
271664
ANTHEM BC/BS ID#
VA
01
—
45748
OPTIMA SENTARA ID#
VA
01
—
5414523
AETNA
VA
01
—
541467765
TAX ID#
VA
01
—
90992
STATE LICENSE
GA
01
—
952279
AETNA ID#
VA
Enumeration date
08/29/2006
Last updated
06/05/2024
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