Provider Demographics
NPI:1467420208
Name:LOTTMAN, JEROME ANDREW (CRNA)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:ANDREW
Last Name:LOTTMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 COLUMNS DR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-9105
Mailing Address - Country:US
Mailing Address - Phone:770-952-6964
Mailing Address - Fax:
Practice Address - Street 1:4106 COLUMNS DR SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-9105
Practice Address - Country:US
Practice Address - Phone:770-952-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN112885367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN112885OtherRN LICENSE NUMBER
GARN112885OtherRN LICENSE NUMBER