Healthcare Provider Details

I. General information

NPI: 1871267542
Provider Name (Legal Business Name): MICHAEL ANDREW POTTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 GOETHALS DR STE 220
RICHLAND WA
99352-3552
US

IV. Provider business mailing address

550 GAGE BLVD STE 101
RICHLAND WA
99352-9532
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-2529
  • Fax: 509-942-2530
Mailing address:
  • Phone: 971-358-2390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number.
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGP61222435
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: