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General NPI Number Information
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NPI Number | 1093123010
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Entity Type | Individual
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Provider Name | WILLIE LLOYD
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Gender | Male
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 07/23/2014
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Provider Practice Location Address
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Address Line | 1659 S HIGHWAY 65 82
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City | LAKE VILLAGE
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State | AR
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Zip | 71653-1661
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Country | US
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Telephone | 870-265-4191
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 BOYD ST
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City | GREENVILLE
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State | MS
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Zip | 38701-5618
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Country | US
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Telephone | 815-549-9411
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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