Healthcare Provider Details

I. General information

NPI: 1538747035
Provider Name (Legal Business Name): LOC LAM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 PRINCE ST STE 101
WARNER ROBINS GA
31093-0713
US

IV. Provider business mailing address

455 PHILIP BLVD BLDG 100
LAWRENCEVILLE GA
30046-8767
US

V. Phone/Fax

Practice location:
  • Phone: 770-962-3462
  • Fax: 770-962-3463
Mailing address:
  • Phone: 770-962-3462
  • Fax: 770-962-3463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13442
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number109516
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10078282
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: