Provider Demographics
NPI:1619170164
Name:LOTT, SHANNON D (DO)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:D
Last Name:LOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 29TH AVE N STE 202
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1448
Mailing Address - Country:US
Mailing Address - Phone:615-327-4304
Mailing Address - Fax:615-327-7940
Practice Address - Street 1:110 29TH AVE N STE 202
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-327-4304
Practice Address - Fax:615-327-7940
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL1104207L00000X
TXN5204207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00891218OtherRR MEDICARE
TX218796501Medicaid
TX8CL591OtherBLUE CROSS BLUE SHIELD
TX8CL591OtherBLUE CROSS BLUE SHIELD