Healthcare Provider Details

I. General information

NPI: 1710177761
Provider Name (Legal Business Name): NATALIE KIDD LLOYD HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

891 DAWSONVILLE HWY #140
GAINESVILLE GA
30501-2640
US

IV. Provider business mailing address

3268 US HIGHWAY 441 S
OKEECHOBEE FL
34974-6239
US

V. Phone/Fax

Practice location:
  • Phone: 770-287-0012
  • Fax: 770-287-0018
Mailing address:
  • Phone: 863-467-1286
  • Fax: 863-763-9705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS000734
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: