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General NPI Number Information
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NPI Number | 1891835021
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Entity Type | Organization
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Legal Business Name | PHILLIP L. POTTER, MD, FACOG, PC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1700 HOSPITAL SOUTH DR SUITE 504
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City | AUSTELL
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State | GA
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Zip | 30106-6810
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Country | US
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Telephone | 770-819-8211
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Fax | 770-819-9616
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Provider Business Mailing Address
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Address Line | 1938 PEACHTREE RD NW SUITE 303
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City | ATLANTA
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State | GA
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Zip | 30309-1267
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Country | US
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Telephone | 404-352-5119
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Fax | 404-352-5330
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. PHILLIP POTTER
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Credential | MD
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Telephone | 404-352-5119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 034220
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License Number State | GA
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