Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 051155 | GA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 51155 | GA |
NPI | 1336146091 |
---|---|
Provider Name | Joshua Edward Lane |
First Address | Columbus, GA 31904-9272 |
Second Address | Columbus, GA 31904-9272 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 29/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E82056 | (02) | GA |