1710928908 NPI number — DR. GEORGE HAROLD LLOYD JR. OD

Table of content: DR. GEORGE HAROLD LLOYD JR. OD (NPI 1710928908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710928908 NPI number — DR. GEORGE HAROLD LLOYD JR. OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LLOYD
Provider First Name:
GEORGE
Provider Middle Name:
HAROLD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710928908
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 229
Provider Second Line Business Mailing Address:
233 CEDAR AVE
Provider Business Mailing Address City Name:
SOUTH PITTSBURG
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-837-8611
Provider Business Mailing Address Fax Number:
423-837-8612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
233 CEDAR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH PITTSBURG
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-837-8611
Provider Business Practice Location Address Fax Number:
423-837-8612
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  ODT860 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3595048 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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