Provider Demographics
NPI:1306404603
Name:LANE, JOSHUA (LAC)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:LANE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 MCCLURE BRIDGE RD STE C304
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8706
Mailing Address - Country:US
Mailing Address - Phone:678-878-3069
Mailing Address - Fax:678-878-4455
Practice Address - Street 1:1549 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4639
Practice Address - Country:US
Practice Address - Phone:678-878-3069
Practice Address - Fax:678-878-4455
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA296171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist