Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1295334639 |
---|---|
Provider Name | Dr. Timothy Stanley Lane |
First Address | Fayetteville, GA 30215-7646 |
Second Address | Peachtree City, GA 30269-1530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2020 |
Last Update Date | 17/10/2020 |