Provider Demographics
NPI:1881675551
Name:LANE, FORREST JAMES JR (DO)
Entity Type:Individual
Prefix:
First Name:FORREST
Middle Name:JAMES
Last Name:LANE
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1889
Mailing Address - Street 2:2406 BELLEVUE RD STE 22
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-1889
Mailing Address - Country:US
Mailing Address - Phone:478-275-4740
Mailing Address - Fax:478-275-0533
Practice Address - Street 1:2406 BELLEVUE RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2842
Practice Address - Country:US
Practice Address - Phone:478-275-4740
Practice Address - Fax:478-275-0533
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2013-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA34641207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00473316FMedicaid
GA00473316FMedicaid
GA05BDDFGMedicare PIN