Provider Demographics
NPI:1093758443
Name:LORD, SYL ALAN (MD)
Entity Type:Individual
Prefix:
First Name:SYL
Middle Name:ALAN
Last Name:LORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4750 WATERS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6200
Mailing Address - Country:US
Mailing Address - Phone:912-350-8712
Mailing Address - Fax:912-350-8753
Practice Address - Street 1:4750 WATERS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6200
Practice Address - Country:US
Practice Address - Phone:912-350-8712
Practice Address - Fax:912-350-8753
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC19122208C00000X
GA032776208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA280000999OtherRR MEDICARE
SCG32776Medicaid
GA000423013HMedicaid
GA000423013JMedicaid
GA000423013JMedicaid
SCG32776Medicaid