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General NPI Number Information
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NPI Number | 1881816700
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Entity Type | Individual
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Provider Name | LLOYDSTONE LEONARD JACOBS II M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 750 HI HOPE ROAD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043
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Country | US
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Telephone | 678-407-6076
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Fax |
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Provider Business Mailing Address
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Address Line | 1128 TWIN BRIDGE LANE
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City | PEACHTREE CITY
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State | GA
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Zip | 30269
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Country | US
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Telephone | 678-364-9727
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Fax | 678-364-9727
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 049179
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License Number State | GA
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