Provider Demographics
NPI:1245374958
Name:LANE, JOSEPH M (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:LANE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13 OFFSHORE RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-1531
Mailing Address - Country:US
Mailing Address - Phone:912-898-0194
Mailing Address - Fax:912-352-3447
Practice Address - Street 1:322 STEPHENSON AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5929
Practice Address - Country:US
Practice Address - Phone:912-352-2992
Practice Address - Fax:912-352-3447
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000937103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00052467BMedicaid