Provider Demographics
NPI:1154926715
Name:WOODALL, LUCAS (PA-C)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:WOODALL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 WHITCHER ST NE STE 3110
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1179
Mailing Address - Country:US
Mailing Address - Phone:770-422-2326
Mailing Address - Fax:
Practice Address - Street 1:EMORY TRANSPLANT CENTER 1365 ECLIFTON RD NE BLDG B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1179
Practice Address - Country:US
Practice Address - Phone:855-366-7989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10276204F00000X, 363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery