Provider Demographics
NPI:1003931874
Name:BOTTI, DEBORAH IDA (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:IDA
Last Name:BOTTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 PEACHTREE RD
Mailing Address - Street 2:SUITE 915
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1107
Mailing Address - Country:US
Mailing Address - Phone:404-812-0011
Mailing Address - Fax:
Practice Address - Street 1:3400 PEACHTREE RD
Practice Address - Street 2:SUITE 915
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1107
Practice Address - Country:US
Practice Address - Phone:404-812-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA291462084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00429B11DMedicaid
GA00429B11DMedicaid
26BDGLSMedicare ID - Type Unspecified