Healthcare Provider Details

I. General information

NPI: 1891225611
Provider Name (Legal Business Name): JOELLE POTTS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 8TH ST
ARCATA CA
95521-5770
US

IV. Provider business mailing address

2434 N AVERS AVE UNIT 2
CHICAGO IL
60647-2224
US

V. Phone/Fax

Practice location:
  • Phone: 707-822-2481
  • Fax: 707-822-3656
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036151770
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A19195
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: