Provider Demographics
NPI:1770638397
Name:LANE, TERESA PARHAM (PMHNP)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:PARHAM
Last Name:LANE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 MAYFIELD RD STE 203
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30009-3012
Mailing Address - Country:US
Mailing Address - Phone:470-805-5040
Mailing Address - Fax:678-268-4550
Practice Address - Street 1:850 MAYFIELD RD STE 203
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30009-3012
Practice Address - Country:US
Practice Address - Phone:470-805-5040
Practice Address - Fax:678-268-4550
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPRN-NP074324363LP0808X
GARN074324163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAS10294Medicare UPIN
GA511I500927Medicare UPIN