Individual provider Active NPI

Lance Christian Anderson

  • Student in an Organized Health Care Education/Training Program
  • Marietta, GA
National Provider Identifier
1902657356
Registry record updated Apr 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
115 Cherry St NE
Marietta, GA 30060-7205
Phone
(770) 793-5700
NPI assigned
Apr 1, 2024
Last updated
Apr 23, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU Primary

Addresses

Primary practice location

115 Cherry St NE
Marietta, GA 30060-7205

Mailing address

1045 Old Peachtree Rd NW Apt 2223
Suwanee, GA 30024-5067
Phone (434) 942-9145

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240625002997 GA Order and Referring Only - Emergency MedicinePractitioner - Emergency Medicine 0345783833

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1711929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1902657356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 OLD PEACHTREE RD NW APT 2223",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300245067",
            "telephone_number": "434-942-9145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 CHERRY ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607205",
            "telephone_number": "770-793-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "LANCE",
        "middle_name": "CHRISTIAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-01",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.