Organization
DERRICK LANE, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DERRICK LANE (OWNER)
(478) 335-1365
Entity
Organization
Contact information
Practice address
818 FORSYTH ST, MACON, GA 31201-2139
(478) 633-7010
(478) 633-7585
Mailing address
PO BOX 28170, MACON, GA 31221-8170
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
052594
GA
Other
Enumeration date
02/05/2013
Last updated
02/05/2013
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