Provider Demographics
NPI:1497251714
Name:LOTT, LEA MCCALLUM
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:MCCALLUM
Last Name:LOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 CASTALIA DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-4860
Mailing Address - Country:US
Mailing Address - Phone:864-992-4833
Mailing Address - Fax:
Practice Address - Street 1:8020 CREEDMOOR RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-4363
Practice Address - Country:US
Practice Address - Phone:919-322-2844
Practice Address - Fax:919-322-2898
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07833363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant