Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 075301 | GA |
N | 207QS0010X | Family Doctor - Sports Medicine | MD.35898 | AL |
N | 208D00000X | General Practice Physician | 75301 | GA |
NPI | 1043548217 |
---|---|
Provider Name | Patrick Justin Lancaster |
First Address | Savannah, GA 31416-2059 |
Second Address | Statesboro, GA 30458-5819 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2009 |
Last Update Date | 14/01/2021 |