Healthcare Provider Details

I. General information

NPI: 1609272921
Provider Name (Legal Business Name): MCKENZIE LOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 SPRINGHILL MEMORIAL DR N
MOBILE AL
36608-1162
US

IV. Provider business mailing address

3610 SPRINGHILL MEMORIAL DR N
MOBILE AL
36608-1162
US

V. Phone/Fax

Practice location:
  • Phone: 251-410-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT2961
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: