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NPI Code Detail

MEDICARE: JOHN E LANIER PA

MEDICARE: JOHN E LANIER PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant2357TN

General Provider Information

NPI Number : 1629419619
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN E LANIER PA
Provider Business Mailing Address
First Line : PO BOX 12197
Second Line :
City : JACKSON
State : TN
Zip : 38308-0136
Country : US
Telephone Number : 731-984-8400
Fax Number :
Provider Business Practice Location Address
First Line : 2075 PLEASANT PLAINS EXT RD
Second Line :
City : JACKSON
State : TN
Zip : 38305-6087
Country : US
Telephone Number : 731-984-8400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2013
Last Update Date : 07/17/2013

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Directions to “ JOHN E LANIER PA” Practice Location

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