Provider Demographics
NPI:1386727360
Name:LANE, PETER JR (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:LANE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:35 JESSE HILL JR DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3032
Mailing Address - Country:US
Mailing Address - Phone:404-785-9800
Mailing Address - Fax:404-785-9745
Practice Address - Street 1:35 JESSE HILL JR DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3032
Practice Address - Country:US
Practice Address - Phone:404-785-9800
Practice Address - Fax:404-785-9745
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA520782080P0207X
GA052078208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E91948Medicare UPIN