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General NPI Number Information
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NPI Number | 1639204498
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Entity Type | Organization
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Legal Business Name | LAWRENCE JOSEPH GOTTS DO PLLC
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 06/27/2011
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Provider Practice Location Address
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Address Line | 1621 S NASHVILLE ST SUITE 104
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City | RUSSELLVILLE
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State | KY
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Zip | 42276
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Country | US
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Telephone | 270-726-4444
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Fax | 270-726-4400
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Provider Business Mailing Address
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Address Line | 1621 S NASHVILLE ST SUITE 104
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City | RUSSELLVILLE
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State | KY
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Zip | 42276
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Country | US
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Telephone | 270-726-4444
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Fax | 270-726-4400
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Authorized Official
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Title or Position | OWNER
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Name | MR. LAWRENCE J. GOTTS
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Credential | DO
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Telephone | 270-726-4444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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