MEDICARE: LINDSAY JOANN DOUGLAS COTA/L

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	174400000X	Specialist	OTA001420	GA

General Provider Information

NPI Number	:	1437498243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY JOANN DOUGLAS COTA/L

Provider Business Mailing Address
First Line	:	890 SPRINGHILL CHURCH RD
Second Line	:
City	:	ALAMO
State	:	GA
Zip	:	30411-3720
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	890 SPRINGHILL CHURCH RD
Second Line	:
City	:	ALAMO
State	:	GA
Zip	:	30411-3720
Country	:	US
Telephone Number	:	229-315-4403
Fax Number	:

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

Provider Enumeration Date	:	02/14/2013
Last Update Date	:	02/14/2013

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