Provider Demographics
NPI:1124280862
Name:LANE, PAUL DOLPHOUS JR (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DOLPHOUS
Last Name:LANE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3527 N VALDOSTA RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-6418
Mailing Address - Country:US
Mailing Address - Phone:229-247-2290
Mailing Address - Fax:229-247-0091
Practice Address - Street 1:3527 N VALDOSTA RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6418
Practice Address - Country:US
Practice Address - Phone:229-247-2290
Practice Address - Fax:229-247-0091
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA003121207X00000X
FLME115924207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5608789OtherAETNA
FL008920900Medicaid
FLI4Q3ROtherBCBS
FLHJ840ZMedicare PIN