Provider Demographics
NPI:1962684001
Name:JUANITA Y LOTT MD PC
Entity type:Organization
Organization Name:JUANITA Y LOTT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUANIT
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-265-5035
Mailing Address - Street 1:418 EH CT
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-2199
Mailing Address - Country:US
Mailing Address - Phone:912-265-5035
Mailing Address - Fax:912-265-1431
Practice Address - Street 1:418 EH CT
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-2199
Practice Address - Country:US
Practice Address - Phone:912-265-5035
Practice Address - Fax:912-265-1431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty