Individual
CAROLINE LOTT DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
205 SHIRLEY AVE, DOUGLAS, GA 31533-2327
(912) 260-5400
(912) 260-5177
Mailing address
PO BOX 1377, DOUGLAS, GA 31534
(912) 384-1477
(912) 384-1470
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005678
GA
363AS0400X
Surgical Physician Assistant
PA9105371
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005678
MEDICAL LICENSE
GA
05
—
858523224F
—
GA
Enumeration date
10/26/2009
Last updated
06/27/2022
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