Healthcare Provider Details

I. General information

NPI: 1881614808
Provider Name (Legal Business Name): WENDY B. POTTS AU.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SAINT JULIAN PL
COLUMBIA SC
29204-2407
US

IV. Provider business mailing address

1601 SAINT JULIAN PL
COLUMBIA SC
29204-2407
US

V. Phone/Fax

Practice location:
  • Phone: 803-777-2642
  • Fax: 803-253-4143
Mailing address:
  • Phone: 803-777-2642
  • Fax: 803-253-4143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3150
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: