Provider Demographics
NPI:1255520466
Name:LLOYD, TRAVIS ERICA (MD)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:ERICA
Last Name:LLOYD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 SNAPFINGER WOODS DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4020
Mailing Address - Country:US
Mailing Address - Phone:770-981-0600
Mailing Address - Fax:770-981-0677
Practice Address - Street 1:5040 SNAPFINGER WOODS DR
Practice Address - Street 2:SUITE 108
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4020
Practice Address - Country:US
Practice Address - Phone:770-981-0600
Practice Address - Fax:770-981-0677
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053065261Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BBRNTMedicare PIN
GA123517Medicare UPIN