Individual
JUSTIN LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1430 JOHN WESLEY GILBERT DR, AUGUSTA, GA 30912-0001
(706) 721-2371
Mailing address
2432 CUMMING RD, AUGUSTA, GA 30904-6110
(912) 687-5807
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
DN123796
GA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/24/2025
Last updated
07/09/2025
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