Healthcare Provider Details

I. General information

NPI: 1811980451
Provider Name (Legal Business Name): SALVATORE JOSEPH LUCIDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 MITCHELL BLVD 23 AMDS/FLIGHT MEDICINE CLINIC
MOODY AFB GA
31699-1500
US

IV. Provider business mailing address

3280 MITCHELL BLVD BLDG 900
MOODY AFB GA
31699-1500
US

V. Phone/Fax

Practice location:
  • Phone: 229-257-2103
  • Fax:
Mailing address:
  • Phone: 229-257-2778
  • Fax: 228-257-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number01052044A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01052044A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: