Individual
LANCE MICKEL CRAIG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5450 WHITTLESEY BLVD, COLUMBUS, GA 31909-2139
(762) 524-7379
Mailing address
5450 WHITTLESEY BLVD, COLUMBUS, GA 31909-2139
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11167
GA
Other
Enumeration date
09/23/2022
Last updated
09/23/2022
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