Provider Demographics
NPI:1235621897
Name:LOTT, JODI EVANS (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:EVANS
Last Name:LOTT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:215 E 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-4249
Mailing Address - Country:US
Mailing Address - Phone:229-276-0100
Mailing Address - Fax:229-276-0300
Practice Address - Street 1:2109 N PATTERSON ST STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2577
Practice Address - Country:US
Practice Address - Phone:229-232-4833
Practice Address - Fax:877-343-0538
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN203572363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily