Provider Demographics
NPI:1265425912
Name:LOCKHART, RICK (MD)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:
Last Name:LOCKHART
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 1:111 FIELDSTONE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-7106
Mailing Address - Country:US
Mailing Address - Phone:478-452-6610
Mailing Address - Fax:478-453-0745
Practice Address - Street 1:111 FIELDSTONE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7106
Practice Address - Country:US
Practice Address - Phone:478-452-6610
Practice Address - Fax:478-453-0745
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2015-09-09
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-11
Provider Licenses
StateLicense IDTaxonomies
GA035287207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00494755AMedicaid
GA00494755AMedicaid
GAO4BDBHHMedicare ID - Type Unspecified