Individual
DERRICK F LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
818 FORSYTH STREET, MACON, GA 31201-2139
(478) 633-7010
Mailing address
P.O. BOX 28170, MACON, GA 31221-8170
(478) 254-5943
(478) 254-6093
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
052594
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
155203137B
—
GA
05
—
155203137C
—
GA
01
—
P00Q81500
RR MEDICARE
GA
Enumeration date
05/12/2006
Last updated
01/11/2011
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