Healthcare Provider Details

I. General information

NPI: 1245254424
Provider Name (Legal Business Name): LLOYD B. SAMPSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 19TH ST
COLUMBUS GA
31901-1528
US

IV. Provider business mailing address

610 19TH ST
COLUMBUS GA
31901-1528
US

V. Phone/Fax

Practice location:
  • Phone: 706-322-7884
  • Fax: 706-660-2142
Mailing address:
  • Phone: 706-322-7884
  • Fax: 706-660-2142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number022179
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: