| Centro Medico San Lucas | |
|
4292 Chamblee Tucker Rd Tucker GA 30084-2103 | |
| (770) 718-1517 | |
| Not Available |
| Full Name | Centro Medico San Lucas |
|---|---|
| Speciality | General Practice |
| Location | 4292 Chamblee Tucker Rd, Tucker, Georgia |
| Authorized Official Name and Position | Byron Oswaldo Mata (OWNER) |
| Authorized Official Contact | 7864274450 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Centro Medico San Lucas 3899 Grassland Loop Lake Mary FL 32746-4120 Ph: (407) 394-2645 | Centro Medico San Lucas 4292 Chamblee Tucker Rd Tucker GA 30084-2103 Ph: (770) 718-1517 |
| NPI Number | 1255933115 |
|---|---|
| Provider Enumeration Date | 11/14/2020 |
| Last Update Date | 11/14/2020 |
| Certification Date | 11/14/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255933115 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | () | Secondary |
| 207QG0300X | Family Medicine - Geriatric Medicine | () | Secondary |
| 208D00000X | General Practice | () | Primary |
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