Provider Demographics
NPI:1265584064
Name:ATCHLEY, LANA BATES (DMD)
Entity type:Individual
Prefix:DR
First Name:LANA
Middle Name:BATES
Last Name:ATCHLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8643 CREEKRISE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-1400
Mailing Address - Country:US
Mailing Address - Phone:706-327-0168
Mailing Address - Fax:
Practice Address - Street 1:3544 HWY 431 NORTH/280 WEST
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867
Practice Address - Country:US
Practice Address - Phone:334-298-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL46171223G0001X
FLDN138021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009957060Medicaid
AL009957060Medicaid