Healthcare Provider Details

I. General information

NPI: 1831078005
Provider Name (Legal Business Name): JOEY DARRELL LANE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2025
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 PARKWOOD DR
BRUNSWICK GA
31520-4722
US

IV. Provider business mailing address

478 SLOAN HILL RD
HORTENSE GA
31543-9851
US

V. Phone/Fax

Practice location:
  • Phone: 912-466-7000
  • Fax:
Mailing address:
  • Phone: 912-506-9561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number347041
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: