Provider Demographics
NPI:1801512199
Name:LANE, SHERRY A (PA)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:A
Last Name:LANE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6500 HALCYON WAY APT 101
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-2393
Mailing Address - Country:US
Mailing Address - Phone:404-667-9227
Mailing Address - Fax:
Practice Address - Street 1:3775 VENTURE DR BLDG F
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5102
Practice Address - Country:US
Practice Address - Phone:404-947-6522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1797363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical