Provider Demographics
NPI:1043548217
Name:LANCASTER, PATRICK JUSTIN (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:JUSTIN
Last Name:LANCASTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15359
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2059
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:912-644-5282
Practice Address - Street 1:16915 HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5819
Practice Address - Country:US
Practice Address - Phone:912-681-2500
Practice Address - Fax:912-681-2025
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA75301208D00000X
ALMD.35898207QS0010X
GA075301207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty