Healthcare Provider Details

I. General information

NPI: 1295292019
Provider Name (Legal Business Name): GEORGE WILLIAM LINDALE POTTS AGACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S STATE ST
DOVER DE
19901-3530
US

IV. Provider business mailing address

640 S. STATE ST MAIL CODE 3055
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-4700
  • Fax: 302-730-0231
Mailing address:
  • Phone: 302-480-1688
  • Fax: 302-730-0231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberLP-0000234
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLP-0000234
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: