Healthcare Provider Details

I. General information

NPI: 1477708188
Provider Name (Legal Business Name): POTENTIAL TECHNOLOGIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 TURTLE CREEK DR
ASHEVILLE NC
28803-3152
US

IV. Provider business mailing address

PO BOX 674
NAPLES NC
28760-0674
US

V. Phone/Fax

Practice location:
  • Phone: 828-231-9125
  • Fax:
Mailing address:
  • Phone: 828-231-9125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. DOUGLAS DANNER
Title or Position: SECRETARY OF CORPORATION
Credential: RN, CNIM
Phone: 828-231-9125