Healthcare Provider Details

I. General information

NPI: 1558527341
Provider Name (Legal Business Name): ZACHARY POTTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 HUFFMAN MILL RD
BURLINGTON NC
27215-8700
US

IV. Provider business mailing address

1234 HUFFMAN MILL RD
BURLINGTON NC
27215-8700
US

V. Phone/Fax

Practice location:
  • Phone: 336-538-1234
  • Fax: 336-538-2390
Mailing address:
  • Phone: 336-538-1234
  • Fax: 336-538-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301092382
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2012-00700
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: