Provider Demographics
NPI:1881742468
Name:LILLARD, PATRICK L (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:L
Last Name:LILLARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 E. HOSPITAL ROAD, 12 WEST
Mailing Address - Street 2:12 WEST
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905
Mailing Address - Country:US
Mailing Address - Phone:706-305-7086
Mailing Address - Fax:706-787-0105
Practice Address - Street 1:300 E. HOSPITAL ROAD
Practice Address - Street 2:ROOM 13A-10
Practice Address - City:FT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-305-7086
Practice Address - Fax:706-787-0105
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC467212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8951821Medicaid
NC130G7OtherBCBS
NC8951821Medicaid