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:
Other - Suffix:
Other - Last Name Type:
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 1:215 E 13TH AVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-4249
Practice Address - Country:US
Practice Address - Phone:229-276-0100
Practice Address - Fax:229-276-0300
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN203572363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health