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General NPI Number Information
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NPI Number | 1033097597
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Entity Type | Individual
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Provider Name | STACY L POTTER
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Gender |
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Dates
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Enumeration Date | 08/23/2025
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Last Update Date | 08/23/2025
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Provider Practice Location Address
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Address Line | 529 LESTER RD
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-5248
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Country | US
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Telephone | 404-425-3780
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Fax | 404-425-3780
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Provider Business Mailing Address
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Address Line | 1336 HIGHWAY 54 W
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-4573
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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