Provider Demographics
NPI:1083644538
Name:LANE, ALBERTA CANADY (PA,)
Entity Type:Individual
Prefix:MS
First Name:ALBERTA
Middle Name:CANADY
Last Name:LANE
Suffix:
Gender:F
Credentials:PA,
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Mailing Address - Street 1:3698 EMBRY CIR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4355
Mailing Address - Country:US
Mailing Address - Phone:770-455-1385
Mailing Address - Fax:770-455-8016
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:111B
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-329-2211
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA615363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical