Healthcare Provider Details

I. General information

NPI: 1962318212
Provider Name (Legal Business Name): LANE BAYLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SUN VALLEY DR STE G1
ROSWELL GA
30076-5639
US

IV. Provider business mailing address

4320 OLD OAK TRCE
CUMMING GA
30041-5688
US

V. Phone/Fax

Practice location:
  • Phone: 770-609-8777
  • Fax:
Mailing address:
  • Phone: 678-977-6851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA003116
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: