Provider Demographics
NPI:1669615175
Name:OTT, KRISTIN PRENTISS (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:PRENTISS
Last Name:OTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:JOY
Other - Last Name:PRENTISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5629 HIGHWAY 21 S
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-9416
Mailing Address - Country:US
Mailing Address - Phone:912-295-2133
Mailing Address - Fax:
Practice Address - Street 1:11705 MERCY BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1711
Practice Address - Country:US
Practice Address - Phone:912-295-2133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069835207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine