| Forrest James Lane Jr, DO | |
|
2406 Bellevue Rd, Dublin, GA 31021-2842 | |
| (478) 275-4740 | |
| (478) 275-0533 |
| Full Name | Forrest James Lane Jr |
|---|---|
| Gender | Male |
| Speciality | Anesthesiology |
| Location | 2406 Bellevue Rd, Dublin, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881675551 | NPI | - | NPPES |
| 00473316F | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207LP2900X | Anesthesiology - Pain Medicine | 34641 (Georgia) | Secondary |
| 207L00000X | Anesthesiology | 34641 (Georgia) | Primary |
| Entity Name | Ams Southeast Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1487107157 PECOS PAC ID: 3870880792 Enrollment ID: O20160921000551 |
| Mailing Address | Practice Location Address |
|---|---|
| Forrest James Lane Jr, DO Po Box 1889, 2406 Bellevue Rd Ste 22, Dublin, GA 31040-1889 Ph: (478) 275-4740 | Forrest James Lane Jr, DO 2406 Bellevue Rd, Dublin, GA 31021-2842 Ph: (478) 275-4740 |
Robert Orr Morris Jr., M.D. Anesthesiology Medicare: Medicare Enrolled Practice Location: 2406 Bellevue Rd, Dublin, GA 31021 Phone: 478-275-4740 Fax: 478-275-0533 | |
Francis Carroll Reese, M.D. Anesthesiology Medicare: Not Enrolled in Medicare Practice Location: 2406 Bellevue Rd, Dublin, GA 31021 Phone: 478-275-4740 Fax: 478-275-0533 | |
David Gerald Shores, D.O. Anesthesiology Medicare: Medicare Enrolled Practice Location: 2406 Bellevue Rd, Dublin, GA 31021 Phone: 478-275-4740 Fax: 478-275-0533 | |
James Harrison Braziel Iii, M.D. Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 2406 Bellevue Rd, Dublin, GA 31021 Phone: 478-275-4740 Fax: 478-275-0533 |