Healthcare Provider Details

I. General information

NPI: 1154434413
Provider Name (Legal Business Name): RANDOLPH GERALD POTTS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 06/13/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 UNION AVE 2 SHORB TOWER
MEMPHIS TN
38104
US

IV. Provider business mailing address

1211 UNION AVE STE 330
MEMPHIS TN
38104-6655
US

V. Phone/Fax

Practice location:
  • Phone: 901-478-5330
  • Fax: 901-478-8358
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2490
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: