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NPI Code Detail

MEDICARE: WENDY B. POTTS AU.D., CCC-A

MEDICARE: WENDY B. POTTS AU.D., CCC-A
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
1231H00000XAudiologist3150SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881614808
Entity Type Code : Individual
Provider Name (Legal Business Name) : WENDY B. POTTS AU.D., CCC-A
Provider Business Mailing Address
First Line : 1601 SAINT JULIAN PL
Second Line :
City : COLUMBIA
State : SC
Zip : 29204-2407
Country : US
Telephone Number : 803-777-2642
Fax Number : 803-253-4143
Provider Business Practice Location Address
First Line : 1601 SAINT JULIAN PL
Second Line :
City : COLUMBIA
State : SC
Zip : 29204-2407
Country : US
Telephone Number : 803-777-2642
Fax Number : 803-253-4143
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 08/12/2008

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