Healthcare Provider Details

I. General information

NPI: 1083156079
Provider Name (Legal Business Name): DIANNE LANIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N ROSEWOOD DR
ALBANY GA
31705-4643
US

IV. Provider business mailing address

206 N ROSEWOOD DR
ALBANY GA
31705-4643
US

V. Phone/Fax

Practice location:
  • Phone: 229-296-2457
  • Fax:
Mailing address:
  • Phone: 229-296-2457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCO137662
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: