Individual
DR. LANE ULRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1120 15TH ST, MEDICAL COLLEGE OF GEORGIA, DEPT. OF OPHTHALMOLOGY, AUGUSTA, GA 30912-0004
(706) 721-1150
(706) 721-6977
Mailing address
1499 WALTON WAY, STE 1400, AUGUSTA, GA 30901-2602
(706) 724-6100
(706) 722-5187
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
23344
SC
207W00000X
Ophthalmology Physician
Primary
44363
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000866192A
—
GA
05
—
G44363
—
SC
Enumeration date
08/13/2006
Last updated
10/05/2011
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