Provider Demographics
NPI:1285670901
Name:GOODMAN, LLOYD STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:STANLEY
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-5502
Mailing Address - Country:US
Mailing Address - Phone:912-350-7171
Mailing Address - Fax:912-350-3454
Practice Address - Street 1:1101 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404
Practice Address - Country:US
Practice Address - Phone:912-350-7171
Practice Address - Fax:912-350-3454
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013215207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA349775OtherWELLCARE
SC150274Medicaid
GAP00649656OtherRR MEDICARE
GA000069935KMedicaid
GA10065589OtherAMERIGROUP
GA000069935JMedicaid
D39986Medicare UPIN
GA511I060271Medicare PIN