Provider Demographics
NPI:1649616194
Name:LANE, ASHLEY SMITH (MD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SMITH
Last Name:LANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:LINEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36266-0098
Mailing Address - Country:US
Mailing Address - Phone:256-396-2141
Mailing Address - Fax:256-396-5884
Practice Address - Street 1:60026 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:LINEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36266-4735
Practice Address - Country:US
Practice Address - Phone:256-396-2141
Practice Address - Fax:256-396-5884
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD33763207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1649616194Medicaid
AL102I084862Medicare PIN