MEDICARE: TIMOTHY ALAN POTTER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	46256	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538340682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY ALAN POTTER MD

Provider Business Mailing Address
First Line	:	3960 KNIGHT ARNOLD RD
Second Line	:	SUITE 206
City	:	MEMPHIS
State	:	TN
Zip	:	38118-3035
Country	:	US
Telephone Number	:	901-271-9500
Fax Number	:	901-271-9501

Provider Business Practice Location Address
First Line	:	4095 AMERICAN WAY
Second Line	:	SUITE 1
City	:	MEMPHIS
State	:	TN
Zip	:	38118-8339
Country	:	US
Telephone Number	:	901-271-9500
Fax Number	:	901-271-9501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2007
Last Update Date	:	01/14/2015

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Directions to “ TIMOTHY ALAN POTTER MD” Practice Location

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