Organization
LANE SPORTS MEDICINE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK KARIM LANE PA (LANE SPORTS MEDICINE OWNER)
(404) 296-5005
Entity
Organization
Contact information
Practice address
2801 N DECATUR RD, SUITE 200, DECATUR, GA 30033-5949
(404) 296-5005
(404) 296-5058
Mailing address
2801 N DECATUR RD, SUITE 200, DECATUR, GA 30033-5949
(404) 296-5005
(404) 296-5058
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GRP7472
MEDICARE GROUP NUMBER
GA
Enumeration date
10/04/2006
Last updated
02/14/2008
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