Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | PT008877 | GA |
NPI | 1528238904 |
---|---|
Provider Name | Mrs. Ann Marie Lucado |
First Address | Lawrenceville, GA 30044-8183 |
Second Address | Lawrenceville, GA 30044-8183 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2008 |
Last Update Date | 03/03/2008 |