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Individual

TRACY LANE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
2221 PEACHTREE RD NE, STE D658, ATLANTA, GA 30309-1148
(404) 855-4503
(404) 855-4503
Mailing address
2221 PEACHTREE RD NE, STE D658, ATLANTA, GA 30309-1148
(404) 855-4503
(404) 855-4503

Taxonomy

Speciality
Code
Description
License number
State
202C00000X
Independent Medical Examiner Physician
Primary
055676
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
535673028B
GA
05
535673028C
GA
Enumeration date
07/31/2006
Last updated
02/23/2017
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