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1417506304
JAKE LANE
MARIETTA, GA
NPI
1417506304
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
367H00000X Anesthesiologist Assistant
Enumeration Date
2019-09-04
Last Update Date
2019-09-24
Business Address
JAKE LANE
677 CHURCH ST NE
MARIETTA, GA 30060-1101
Phone number: 770-794-0477
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Mailing Address
JAKE LANE
531 ROSELANE ST NW STE 830
MARIETTA, GA 30060-6979
Phone number: 770-794-0477
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