Provider Demographics
NPI:1962706960
Name:LANIER INTERNAL MEDICINE
Entity type:Organization
Organization Name:LANIER INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-756-1428
Mailing Address - Street 1:#2 - 48TH STREET
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854
Mailing Address - Country:US
Mailing Address - Phone:334-756-2136
Mailing Address - Fax:334-756-4184
Practice Address - Street 1:#2 - 48TH STREET
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854
Practice Address - Country:US
Practice Address - Phone:334-756-2136
Practice Address - Fax:334-756-4184
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHATTAHOOCHIE VALLEY HOSPITAL SOCIETY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD8463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty