Provider Demographics
NPI:1003699240
Name:LANE, BARBARA MALLORY (NP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:MALLORY
Last Name:LANE
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3541 N CROSSING CIR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1019
Mailing Address - Country:US
Mailing Address - Phone:229-244-4200
Mailing Address - Fax:
Practice Address - Street 1:3541 N CROSSING CIR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1019
Practice Address - Country:US
Practice Address - Phone:229-244-4200
Practice Address - Fax:229-244-4995
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN2031452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry