Provider Demographics
NPI:1124224159
Name:STOTTS, JOSEPH M
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:STOTTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5736 MANCHESTER HWY.
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37357
Mailing Address - Country:US
Mailing Address - Phone:931-815-3871
Mailing Address - Fax:931-815-3876
Practice Address - Street 1:5736 MANCHESTER HWY.
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:TN
Practice Address - Zip Code:37357
Practice Address - Country:US
Practice Address - Phone:931-815-3871
Practice Address - Fax:931-815-3876
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
TN7915104100000X
TN59191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker