Provider Demographics
NPI:1710040167
Name:LANUM, JOAN ALLISON (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:ALLISON
Last Name:LANUM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 GENERAL LEE RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-1517
Mailing Address - Country:US
Mailing Address - Phone:478-474-4073
Mailing Address - Fax:478-474-4074
Practice Address - Street 1:3626 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-1853
Practice Address - Country:US
Practice Address - Phone:478-474-4073
Practice Address - Fax:478-474-4074
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002796103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical