1215976394 NPI number — JOHN PALMER LANIER M.D.

Table of content: JOHN PALMER LANIER M.D. (NPI 1215976394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215976394 NPI number — JOHN PALMER LANIER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANIER
Provider First Name:
JOHN
Provider Middle Name:
PALMER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215976394
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2050 CUMMING HWY
Provider Second Line Business Mailing Address:
STE. 100
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30114-8614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-345-9600
Provider Business Mailing Address Fax Number:
770-345-9611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 KENNESAW DUE WEST RD NW
Provider Second Line Business Practice Location Address:
SUITE 501
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30152-4301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-429-5555
Provider Business Practice Location Address Fax Number:
770-429-5586
Provider Enumeration Date:
06/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  028809 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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