Healthcare Provider Details

I. General information

NPI: 1336182450
Provider Name (Legal Business Name): GREGORY J. POTTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9420 BROWNSBORO RD
LOUISVILLE KY
40241-1118
US

IV. Provider business mailing address

PO BOX 950248
LOUISVILLE KY
40295-0248
US

V. Phone/Fax

Practice location:
  • Phone: 502-426-4264
  • Fax: 502-426-4221
Mailing address:
  • Phone: 502-253-1035
  • Fax: 502-253-1037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number30295
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: