Healthcare Provider Details

I. General information

NPI: 1639110877
Provider Name (Legal Business Name): LANA CANKOVIC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 ROSELANE STREET NW SUITE 750
MARIETTTA GA
30060
US

IV. Provider business mailing address

51 ROSELANE STREET NW SUITE 750
MARIETTTA GA
30060
US

V. Phone/Fax

Practice location:
  • Phone: 770-794-0477
  • Fax: 770-794-3108
Mailing address:
  • Phone: 770-794-0477
  • Fax: 770-794-3108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25350
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number055186
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: