Provider Demographics
NPI:1831298892
Name:SKELTON, LANA (MD)
Entity Type:Individual
Prefix:DR
First Name:LANA
Middle Name:
Last Name:SKELTON
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 1:3226 HAMPTON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4225
Mailing Address - Country:US
Mailing Address - Phone:912-264-0760
Mailing Address - Fax:912-264-5798
Practice Address - Street 1:3226 HAMPTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4225
Practice Address - Country:US
Practice Address - Phone:912-264-0760
Practice Address - Fax:912-264-5798
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAS6862040174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00094311CMedicaid
GA00094311CMedicaid
GA00094311CMedicaid