Derrick Lane, MD, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

052594 Issued in GA

Legal business name

DERRICK LANE, MD, LLC

Practice address

818 Forsyth St
Macon, GA 31201-2139

Phone

(478) 633-7010

Fax

(478) 633-7585

NPI assigned

Feb 5, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Derrick LaneNPI 1124079447

Title

Owner

Phone

(478) 335-1365

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Derrick F Lane, M.D.

  • Family Medicine Physician
  • Macon, GA
  • NPI 1124079447
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1360022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360022400000",
    "number": "1750620191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 28170",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312218170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 FORSYTH ST",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312012139",
            "telephone_number": "478-633-7010",
            "fax_number": "478-633-7585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERRICK LANE, MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-05",
        "last_updated": "2013-02-05",
        "status": "A",
        "authorized_official_last_name": "LANE",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "478-335-1365",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "052594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marsha Thorn Denny, FNP
• Ashley Dent
• Dental Care Center of Macon, PC
• Dental Sleep Therapy of Macon LLC
• Dental Wellness Center of Macon, LLC
• Judith Loudon Derriso, LCSW
• Jaimin Desai, DMD
• Niraj Desai, MD
• Developing Minds Treatment Center, LLC
• Sharon Devereaux

• Family Medicine Physician in Macon, GA
• Providers in Macon, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.