Provider Demographics
NPI:1386791879
Name:LOTT, TAMIKA JO (MD)
Entity type:Individual
Prefix:DR
First Name:TAMIKA
Middle Name:JO
Last Name:LOTT
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Gender:
Credentials:MD
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Mailing Address - Street 1:979 GLENWOOD AVE SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-1815
Mailing Address - Country:US
Mailing Address - Phone:336-314-0186
Mailing Address - Fax:336-717-0711
Practice Address - Street 1:33 UPPER RIVERDALE RD SW STE 10
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2617
Practice Address - Country:US
Practice Address - Phone:770-968-7933
Practice Address - Fax:770-996-3941
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2025-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC200400230207Q00000X
GA64138207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF17439Medicare UPIN
NCF17439Medicare ID - Type Unspecified