Provider Demographics
NPI:1316904923
Name:LANCASTER, THADDEUS IVORY (MD)
Entity type:Individual
Prefix:DR
First Name:THADDEUS
Middle Name:IVORY
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 116156
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6156
Mailing Address - Country:US
Mailing Address - Phone:470-325-0100
Mailing Address - Fax:470-325-0193
Practice Address - Street 1:3855 PLEASANT HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8030
Practice Address - Country:US
Practice Address - Phone:678-312-7800
Practice Address - Fax:678-312-7818
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD073192207V00000X
GA73192207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology