MEDICARE: DR. ELMER RAY POTTS ED.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	P1312	TN

General Provider Information

NPI Number	:	1285740563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELMER RAY POTTS ED.D.

Provider Business Mailing Address
First Line	:	PO BOX 158761
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-8761
Country	:	US
Telephone Number	:	615-481-5071
Fax Number	:	615-383-5863

Provider Business Practice Location Address
First Line	:	4219 HILLSBORO PIKE
Second Line	:	SUITE 306
City	:	NASHVILLE
State	:	TN
Zip	:	37215-3328
Country	:	US
Telephone Number	:	615-481-5071
Fax Number	:	615-383-5863

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/21/2012

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