Provider Demographics
NPI:1407846777
Name:LOTT, CHARLES EDMONDSON (PA-C)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDMONDSON
Last Name:LOTT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 VANDERBILT PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2476
Mailing Address - Country:US
Mailing Address - Phone:828-258-0397
Mailing Address - Fax:
Practice Address - Street 1:4 VANDERBILT PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2476
Practice Address - Country:US
Practice Address - Phone:828-258-0397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103799363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP97973Medicare UPIN
NC2759496AMedicare ID - Type UnspecifiedMEDICARE ID #