Provider Demographics
NPI:1386663367
Name:LLOYD, LANCELOT A (MD)
Entity Type:Individual
Prefix:DR
First Name:LANCELOT
Middle Name:A
Last Name:LLOYD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 MULKEY RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1118
Mailing Address - Country:US
Mailing Address - Phone:678-383-6970
Mailing Address - Fax:678-383-6973
Practice Address - Street 1:1680 MULKEY RD
Practice Address - Street 2:SUITE E
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1118
Practice Address - Country:US
Practice Address - Phone:678-383-6970
Practice Address - Fax:678-383-6973
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA59816207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA210231259BMedicaid
GA202I113290OtherMEDICARE FOR TYPE 1 NPI
GA202I113290OtherMEDICARE FOR TYPE 1 NPI