Provider Demographics
NPI:1215974100
Name:LOMBOY, JOSEPH STEPHEN R (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH STEPHEN
Middle Name:R
Last Name:LOMBOY
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 1:1018 KEITH DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2947
Mailing Address - Country:US
Mailing Address - Phone:478-987-7444
Mailing Address - Fax:478-987-7747
Practice Address - Street 1:1018 KEITH DR
Practice Address - Street 2:SUITE A
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2947
Practice Address - Country:US
Practice Address - Phone:478-987-7444
Practice Address - Fax:478-987-7747
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047921207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000892768BMedicaid
GA000892768FMedicaid
GA000892768BMedicaid
GA000892768FMedicaid
H31438Medicare UPIN