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General NPI Number Information
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NPI Number | 1326736703
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Entity Type | Individual
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Provider Name | SHANTHI POTLA
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Gender | Female
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Dates
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Enumeration Date | 04/25/2023
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 807 JACKSON ST
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City | ALEXANDRIA
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State | LA
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Zip | 71301-7656
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Country | US
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Telephone | 318-441-1034
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Fax |
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Provider Business Mailing Address
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Address Line | 4043 STARLIGHT CREEK DR
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City | CELINA
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State | TX
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Zip | 75009-1597
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Country | US
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Telephone | 858-699-5499
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 0101283962
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 346368
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101283962
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0101283962
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 346368
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License Number State | LA
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101283962
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License Number State | VA
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Taxonomy #7
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 346368
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License Number State | LA
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Taxonomy #8
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0101283962
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License Number State | VA
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Taxonomy #9
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 346368
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License Number State | LA
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