Basic Information
| Provider Information | |||||||||
| NPI: | 1124224159 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOTTS | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5736 MANCHESTER HWY. | ||||||||
| Address2: | |||||||||
| City: | MORRISON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9318153871 | ||||||||
| FaxNumber: | 9318153876 | ||||||||
| Practice Location | |||||||||
| Address1: | 5736 MANCHESTER HWY. | ||||||||
| Address2: | |||||||||
| City: | MORRISON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9318153871 | ||||||||
| FaxNumber: | 9318153876 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 10/27/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 104100000X | 7915 | TN | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 5919 | TN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.