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General NPI Number Information
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NPI Number | 1952665556
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Entity Type | Individual
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Provider Name | ALYSON LANE FNP
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Gender | Female
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Dates
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Enumeration Date | 06/28/2012
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 687 JOHNSON FERRY RD
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City | MARIETTA
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State | GA
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Zip | 30068-4628
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Country | US
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Telephone | 770-977-9220
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Fax |
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Provider Business Mailing Address
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Address Line | 803 SERRAMONTE DR
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City | MARIETTA
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State | GA
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Zip | 30068-4652
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Country | US
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Telephone | 404-277-2866
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN186973
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License Number State | GA
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