Provider Demographics
NPI:1215565742
Name:BOTT, ANGELA LYNNE (DO)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LYNNE
Last Name:BOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 ROSS CLARK CIR STE 700
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3043
Mailing Address - Country:US
Mailing Address - Phone:334-793-5105
Mailing Address - Fax:
Practice Address - Street 1:1118 ROSS CLARK CIR STE 700
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3030
Practice Address - Country:US
Practice Address - Phone:334-793-5105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO3602207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology