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MARIAN LANE MD
>> Emergency Medicine >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1689603672
Individual Registrant: MARIAN LANE MD
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
215 MIMS RD SYLVANIA, GA 30467-1994 US
Tel: 904-805-1300 Fax: 904-805-1302
Tel: 904-805-1300 Fax: 904-805-1302
Contact information for business:
PO BOX 532768 ATLANTA, GA 30353-2768 US
Tel: 904-805-1300 Fax: 904-805-1302
Tel: 904-805-1300 Fax: 904-805-1302
Registration Information:
NPI: 1689603672
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 207P00000X | Allopathic & Osteopathic Physicians Emergency Medicine | GA | 21262 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| BLUE CROSS | 027300 | GA | 01 |
| RAILROAD MEDICARE | P00410868 | GA | 01 |
