Individual
MISS JUANITA YVONNE LOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
418 EH COURT, BRUNSWICK, GA 31520
(912) 265-5035
(912) 265-1431
Mailing address
3421 TROUT ST, BRUNSWICK, GA 31520
(912) 264-3095
(912) 265-1431
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
019847
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00181596A
—
GA
01
—
019847
STATE
—
01
—
85001571G
GBHC
—
Enumeration date
08/30/2006
Last updated
03/07/2023
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