Provider Demographics
NPI:1669947768
Name:MOTT, GEOFFREY C
Entity type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:C
Last Name:MOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 W GENESEE AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-3723
Mailing Address - Country:US
Mailing Address - Phone:989-799-1266
Mailing Address - Fax:989-799-1548
Practice Address - Street 1:2700 W GENESEE AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3723
Practice Address - Country:US
Practice Address - Phone:989-799-1266
Practice Address - Fax:989-799-1548
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIM300275108174172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver