Healthcare Provider Details

I. General information

NPI: 1851313266
Provider Name (Legal Business Name): JEFFERY S POTTER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 09/17/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 WEDDINGTON BRANCH RD STE B
PIKEVILLE KY
41501-3296
US

IV. Provider business mailing address

1709 KY ROUTE 321 STE 3
PRESTONSBURG KY
41653-9097
US

V. Phone/Fax

Practice location:
  • Phone: 606-637-6377
  • Fax:
Mailing address:
  • Phone: 606-349-7474
  • Fax: 606-349-7737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number02805
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02805
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02805
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: