Provider Demographics
NPI:1558668087
Name:HORIZON MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:HORIZON MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCELOT
Authorized Official - Middle Name:A
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-374-6189
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:803-374-6189
Mailing Address - Fax:770-944-1013
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:803-374-6189
Practice Address - Fax:770-944-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059816207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1386663367OtherTYPE 1 (INDIVIDUAL) NPI
SC278808Medicaid
I49265Medicare UPIN