Provider Demographics
NPI:1467849026
Name:LANE, MORGAN (MD)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N BROAD ST STE 202
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5178
Mailing Address - Country:US
Mailing Address - Phone:229-344-4315
Mailing Address - Fax:
Practice Address - Street 1:100 MIMOSA DR FL 3
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6676
Practice Address - Country:US
Practice Address - Phone:229-226-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL38530208600000X
GA89612208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty