Basic Information
| Provider Information | |||||||||
| NPI: | 1093758443 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LORD | ||||||||
| FirstName: | SYL | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4750 WATERS AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314046200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123508712 | ||||||||
| FaxNumber: | 9123508753 | ||||||||
| Practice Location | |||||||||
| Address1: | 4750 WATERS AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314046200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123508712 | ||||||||
| FaxNumber: | 9123508753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | 19122 | SC | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208C00000X | 032776 | GA | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
ID Information
| ID | Type | State | Issuer | Description | 280000999 | 01 | GA | RR MEDICARE | OTHER | G32776 | 05 | SC | MEDICAID | 000423013H | 05 | GA | MEDICAID | 000423013J | 05 | GA | MEDICAID |