Healthcare Provider Details

I. General information

NPI: 1154134369
Provider Name (Legal Business Name): LANEY OLSON DAT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CAMPUS DRIVE
TALLULAH FALLS GA
30573
US

IV. Provider business mailing address

26 DOYLE STREET UNIT 204
TOCCOA GA
30577
US

V. Phone/Fax

Practice location:
  • Phone: 762-285-9544
  • Fax:
Mailing address:
  • Phone: 618-751-4437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT004670
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: