Healthcare Provider Details

I. General information

NPI: 1992632574
Provider Name (Legal Business Name): LANE LAWSON CARROLL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 RADIO HILL RD
MARION VA
24354-6587
US

IV. Provider business mailing address

1161 MOORLAND AVE
BRISTOL VA
24201-2775
US

V. Phone/Fax

Practice location:
  • Phone: 276-944-6342
  • Fax:
Mailing address:
  • Phone: 423-300-3175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: