MEDICARE: MICHAEL S LOTT SR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0000X	Pain Medicine Physician	060927	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202I052818	OTHER	GA	MDCR#

General Provider Information

NPI Number	:	1316122922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL S LOTT SR. MD

Provider Business Mailing Address
First Line	:	280 MERCHANTS SQ
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30132-5029
Country	:	US
Telephone Number	:	678-813-2741
Fax Number	:	770-575-3912

Provider Business Practice Location Address
First Line	:	280 MERCHANTS SQ
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30132-5029
Country	:	US
Telephone Number	:	678-813-2741
Fax Number	:	770-575-3912

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2008
Last Update Date	:	11/30/2015

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