1346610789 NPI number — UNLIMITED SPECTRUM, LLC

Table of content: WILLIAM ROBERT LUCAS JR. MD (NPI 1053388074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346610789 NPI number — UNLIMITED SPECTRUM, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNLIMITED SPECTRUM, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
UNLIMITED SPECTRUM COUNSELING
Provider Other Organization Name Type Code:
5
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:
1346610789
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4410 KINGSFIELD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNWOODY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30338-6636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-840-2111
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4536 BARCLAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30338-7145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-458-8711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KINGMAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
404-840-2111

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  APC004656 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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