Provider Demographics
NPI:1508895111
Name:MCLANE, LLOYD TIMOTHY (ATC)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:TIMOTHY
Last Name:MCLANE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 ALDER WAY
Mailing Address - Street 2:APT 407
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-9119
Mailing Address - Country:US
Mailing Address - Phone:904-476-8459
Mailing Address - Fax:
Practice Address - Street 1:937 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0008
Practice Address - Country:US
Practice Address - Phone:706-836-6949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL00000012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL0000001OtherSTATE LICENSE
SC1326OtherSTATE LICENSES
GAAT001723OtherSTATE LICENSE
000090290OtherNATIONAL BOARD