Provider Demographics
NPI:1134160278
Name:LANE, BARBARA P (RD)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:P
Last Name:LANE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:BARBARA
Other - Middle Name:P
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2501 N PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1735
Mailing Address - Country:US
Mailing Address - Phone:229-259-4997
Mailing Address - Fax:229-249-5060
Practice Address - Street 1:2501 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1735
Practice Address - Country:US
Practice Address - Phone:229-259-4997
Practice Address - Fax:229-249-5060
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001257133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA71BBBHSMedicare ID - Type UnspecifiedMEDICARE
GAP78912Medicare UPIN