Provider Demographics
NPI:1841748894
Name:LANE, REESHEMAH
Entity Type:Individual
Prefix:
First Name:REESHEMAH
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:GA
Mailing Address - Zip Code:31620-3239
Mailing Address - Country:US
Mailing Address - Phone:229-402-9460
Mailing Address - Fax:
Practice Address - Street 1:307 S MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620-3239
Practice Address - Country:US
Practice Address - Phone:229-402-9460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor