Individual
MRS. KIMBERLY LOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 DOCTORS DR STE G, DOUGLAS, GA 31533-2211
(912) 384-6186
(912) 384-6187
Mailing address
PO BOX 1377, DOUGLAS, GA 31534-1377
(912) 384-1477
(912) 384-1470
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004095
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004095
MEDICAL LICENSE
GA
05
—
173328689A
—
GA
05
—
173328689B
—
GA
05
—
173328689C
—
GA
Enumeration date
04/20/2006
Last updated
07/21/2022
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