Healthcare Provider Details

I. General information

NPI: 1154365377
Provider Name (Legal Business Name): LANCE D ATKINSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 3RD ST
MACON GA
31201-3404
US

IV. Provider business mailing address

124 3RD ST
MACON GA
31201-3404
US

V. Phone/Fax

Practice location:
  • Phone: 478-751-2900
  • Fax: 478-751-2949
Mailing address:
  • Phone: 478-751-2900
  • Fax: 478-751-2949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number059365
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: