Provider Demographics
NPI:1962780353
Name:LUCAS, MARILYN RAMSEY (DPT)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:RAMSEY
Last Name:LUCAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:RAMSEY
Other - Last Name:HEFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:900 CIRCLE 75 PKWY SE
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3035
Mailing Address - Country:US
Mailing Address - Phone:770-953-6929
Mailing Address - Fax:770-953-6972
Practice Address - Street 1:105 COLLIER RD NW
Practice Address - Street 2:SUITE 2000
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1710
Practice Address - Country:US
Practice Address - Phone:404-352-1053
Practice Address - Fax:404-350-0840
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019950225100000X
GAPT010399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist