MEDICARE: FORREST JAMES LANE JR. D.O.

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
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	34641	GA
2	207L00000X	Anesthesiology Physician	34641	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881675551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FORREST JAMES LANE JR. D.O.

Provider Business Mailing Address
First Line	:	PO BOX 1889
Second Line	:	2406 BELLEVUE RD STE 22
City	:	DUBLIN
State	:	GA
Zip	:	31040-1889
Country	:	US
Telephone Number	:	478-275-4740
Fax Number	:	478-275-0533

Provider Business Practice Location Address
First Line	:	2406 BELLEVUE RD
Second Line	:
City	:	DUBLIN
State	:	GA
Zip	:	31021-2842
Country	:	US
Telephone Number	:	478-275-4740
Fax Number	:	478-275-0533

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	06/14/2024

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Directions to “ FORREST JAMES LANE JR. D.O.” Practice Location

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