Provider Demographics
NPI:1134380322
Name:LUCY, JOHN R (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:LUCY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3340
Mailing Address - Country:US
Mailing Address - Phone:404-513-6077
Mailing Address - Fax:404-478-6823
Practice Address - Street 1:125 E TRINITY PL
Practice Address - Street 2:202
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3360
Practice Address - Country:US
Practice Address - Phone:404-513-6077
Practice Address - Fax:404-478-6823
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1911103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical