NPIMap

Organization Active NPI

Lucas Pediatrics, PC

  • Pediatrics Physician
  • Roswell, GA
National Provider Identifier
1093982746
Registry record updated May 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
038040 Issued in GA
Legal business name
LUCAS PEDIATRICS, PC
Practice address
622 W Crossville Rd Ste 100
Roswell, GA 30075-2560
Phone
(770) 645-2250
Fax
(770) 643-5850
NPI assigned
May 13, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robin M Wilson
Title
Billing Manager
Phone
(770) 645-2250

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 038040 GA Primary

Addresses

Primary practice location

622 W Crossville Rd Ste 100
Roswell, GA 30075-2560

Mailing address

622 W Crossville Rd Ste 100
Roswell, GA 30075-2560
Phone (770) 645-2250

Other identifiers 1

IdentifierTypeStateIssuer
000580016EMedicaidGA

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210636800000",
    "number": "1093982746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 W CROSSVILLE RD STE 100",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300752560",
            "telephone_number": "770-645-2250",
            "fax_number": "770-643-5850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W CROSSVILLE RD STE 100",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300752560",
            "telephone_number": "770-645-2250",
            "fax_number": "770-643-5850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUCAS PEDIATRICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-13",
        "last_updated": "2008-05-13",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "770-645-2250"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "038040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000580016E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.