Healthcare Provider Details

I. General information

NPI: 1730716689
Provider Name (Legal Business Name): ASHLEIGH POTTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BLUFF AVE
NORTH AUGUSTA SC
29841-3862
US

IV. Provider business mailing address

3696 WHEELER RD
AUGUSTA GA
30909-6520
US

V. Phone/Fax

Practice location:
  • Phone: 803-624-1313
  • Fax: 803-426-9236
Mailing address:
  • Phone: 706-736-1830
  • Fax: 706-650-7553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23782
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN297123
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN297123
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: