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General NPI Number Information
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NPI Number | 1609931658
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Entity Type | Organization
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Legal Business Name | ASHLAND CHILDREN'S CLINIC
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 700 13TH ST
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City | ASHLAND
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State | KY
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Zip | 41101-2620
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Country | US
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Telephone | 606-329-0204
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Fax | 606-324-7770
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Provider Business Mailing Address
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Address Line | 700 13TH ST
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City | ASHLAND
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State | KY
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Zip | 41101-2620
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Country | US
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Telephone | 606-329-0204
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Fax | 606-324-7770
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN ROGER POTTER
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Credential | MD
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Telephone | 606-329-0204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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