Healthcare Provider Details

I. General information

NPI: 1033139985
Provider Name (Legal Business Name): DAVID W POTTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 MONTGOMERY DR
ANDERSON SC
29621-3334
US

IV. Provider business mailing address

PO BOX 2047
ANDERSON SC
29622-2047
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-3915
  • Fax: 864-260-3920
Mailing address:
  • Phone: 864-512-3879
  • Fax: 864-512-2083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number10374
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier103747
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: