Individual
CYRENAH NICOLE LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
116 E 4TH AVE, CORDELE, GA 31015-3210
(229) 276-3677
(229) 276-3679
Mailing address
902 N 7TH ST STE 140E, CORDELE, GA 31015-3270
(229) 276-3100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
84720
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003192565C
—
GA
Enumeration date
04/18/2017
Last updated
09/29/2021
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