Individual
MRS. KIMBERLY LOTT
Active
Individual
MRS. KIMBERLY LOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
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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