Provider Demographics
NPI:1548206717
Name:LOTT, JIMMY WALTER (MD)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:WALTER
Last Name:LOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:970 LAKELAND DR
Mailing Address - Street 2:SUITE 61
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4635
Mailing Address - Country:US
Mailing Address - Phone:601-982-7850
Mailing Address - Fax:601-718-5145
Practice Address - Street 1:970 LAKELAND DR
Practice Address - Street 2:SUITE 61
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4635
Practice Address - Country:US
Practice Address - Phone:601-982-7850
Practice Address - Fax:601-718-5145
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11383207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115249Medicaid
F45789Medicare UPIN
MS00115249Medicaid