Provider Demographics
NPI:1184788812
Name:ZOTTOLI, LAWRENCE F (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:F
Last Name:ZOTTOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ST. JOSEPH'S CANDLER DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322
Mailing Address - Country:US
Mailing Address - Phone:912-748-1999
Mailing Address - Fax:912-748-3847
Practice Address - Street 1:101 ST. JOSEPH CANDLER DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322
Practice Address - Country:US
Practice Address - Phone:912-748-1999
Practice Address - Fax:912-748-3847
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA036639207Q00000X
GA036639207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00531286BMedicaid
GA80042552OtherRAILROAD PROVIDER NUMBER
GAC72928Medicare UPIN
GA08BBRLQMedicare ID - Type UnspecifiedPROVIDER MEDICARE NUMBER