1215399092 NPI number — DR. LUCAS E WILMORE

Table of content: DR. LUCAS E WILMORE (NPI 1215399092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215399092 NPI number — DR. LUCAS E WILMORE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILMORE
Provider First Name:
LUCAS
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215399092
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
854 W JAMES CAMPBELL BLVD, SUITE 303
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-540-4255
Provider Business Mailing Address Fax Number:
931-490-4654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
143 SE PARKWAY CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37064-3968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-790-0567
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  3763 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , with the licence number: 101770796 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QA0401X , with the licence number: 3763 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2026 www.npivalidator.com