Provider Demographics
NPI:1245224344
Name:LORD, DANIEL BRADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BRADLEY
Last Name:LORD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:721 WELLNESS WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046
Mailing Address - Country:US
Mailing Address - Phone:770-995-7989
Mailing Address - Fax:770-339-8646
Practice Address - Street 1:3855 PLEASANT HILL ROAD
Practice Address - Street 2:SUITE 230
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:770-495-8300
Practice Address - Fax:770-495-7646
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2012-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA038852207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6943OtherPROMINA
GA4575100OtherMANAGE CARE
GA7462612OtherCIGNA PPO
GA100012565OtherRAIL ROAD MEDICARE
GA29-06974OtherUNITED HEALTHCARE
GA582061514003OtherPRUDENTIAL
GA6943OtherONE HEALTH
GA000623136AMedicaid
GA52495718OtherBLUE CROSS BLUE SHIELD
GA7462612OtherCIGNA PPO
GA52495718OtherBLUE CROSS BLUE SHIELD