Healthcare Provider Details

I. General information

NPI: 1285740563
Provider Name (Legal Business Name): ELMER RAY POTTS ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4219 HILLSBORO PIKE SUITE 306
NASHVILLE TN
37215-3328
US

IV. Provider business mailing address

PO BOX 158761
NASHVILLE TN
37215-8761
US

V. Phone/Fax

Practice location:
  • Phone: 615-481-5071
  • Fax: 615-383-5863
Mailing address:
  • Phone: 615-481-5071
  • Fax: 615-383-5863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP1312
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: