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General NPI Number Information
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NPI Number | 1497251714
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Entity Type | Individual
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Provider Name | LEA MCCALLUM LOTT
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Gender | Female
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 04/13/2018
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Provider Practice Location Address
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Address Line | 8020 CREEDMOOR RD
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City | RALEIGH
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State | NC
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Zip | 27613-4363
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Country | US
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Telephone | 919-322-2844
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Fax | 919-322-2898
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Provider Business Mailing Address
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Address Line | 1303 CASTALIA DR
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City | CARY
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State | NC
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Zip | 27513-4860
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Country | US
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Telephone | 864-992-4833
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-07833
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License Number State | NC
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