Provider Demographics
NPI:1215976394
Name:LANIER, JOHN PALMER (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PALMER
Last Name:LANIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2050 CUMMING HWY
Mailing Address - Street 2:STE. 100
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8614
Mailing Address - Country:US
Mailing Address - Phone:770-345-9600
Mailing Address - Fax:770-345-9611
Practice Address - Street 1:1600 KENNESAW DUE WEST RD NW
Practice Address - Street 2:SUITE 501
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4301
Practice Address - Country:US
Practice Address - Phone:770-429-5555
Practice Address - Fax:770-429-5586
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2012-02-01
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Provider Licenses
StateLicense IDTaxonomies
GA028809208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD65343Medicare UPIN
GA25BBFWFMedicare PIN