Provider Demographics
NPI:1336146091
Name:LANE, JOSHUA EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:EDWARD
Last Name:LANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 BROOKSTONE CENTRE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9272
Mailing Address - Country:US
Mailing Address - Phone:706-322-1717
Mailing Address - Fax:706-322-1718
Practice Address - Street 1:1210 BROOKSTONE CENTRE PARKWAY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9272
Practice Address - Country:US
Practice Address - Phone:706-322-1717
Practice Address - Fax:706-322-1718
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051155207N00000X
GA51155207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE82056Medicare UPIN