DEVON POTLER-JACK (NPI# 1578180535) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578180535 |
| Entity Type | Individual |
| Full Name | DEVON POTLER-JACK |
| Practice Address |
677 Church St Ne Marietta GA 30060-1101 |
| Mailing Address |
982 Virginia Ave Ne Apt 2 Atlanta GA 30306-3608 |
| Practice Telephone | 7707935000 |
| Mailing Telephone | 6789946719 |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2020-06-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367H00000X | Anesthesiologist Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
677 CHURCH ST NE |
| City | MARIETTA |
| State | GA |
| Zip Code | 30060-1101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841285095 | Grace S Kim | Anesthesiology | 677 Church St Ne, Marietta, GA 30060-1101 | 2005-09-14 |
| 1205436425 | Lakesha Alexis | Nurse Practitioner | 677 Church St Ne, Marietta, GA 30060-1101 | 2020-10-27 |
| 1710594080 | Terrence Helms | Nurse Anesthetist, Certified Registered | 677 Church St Ne, Marietta, GA 30060-1101 | 2020-09-30 |
| 1063022481 | Laura Elliott | Registered Nurse | 677 Church St Ne, Marietta, GA 30060-1101 | 2020-08-01 |
| 1346868908 | Megan Grace Zimmerman | Anesthesiologist Assistant | 677 Church St Ne, Marietta, GA 30060-1101 | 2020-07-10 |
| 1740802032 | Noelle Shaw | Anesthesiologist Assistant | 677 Church St Ne, Marietta, GA 30060-1101 | 2020-05-11 |
| 1316567860 | Molly O'keeffe | Registered Nurse | 677 Church St Ne, Marietta, GA 30060-1101 | 2020-04-24 |
| 1740800317 | Sara Roberts | Registered Nurse | 677 Church St Ne, Marietta, GA 30060-1101 | 2020-04-23 |
| 1508486184 | Luke Bishop | Student in an Organized Health Care Education/Training Program | 677 Church St Ne, Marietta, GA 30060-1101 | 2020-04-23 |
| 1487274239 | Mahtab Melissa Parham | Student in an Organized Health Care Education/Training Program | 677 Church St Ne, Marietta, GA 30060-1101 | 2020-04-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144845116 | Legacy Center for Spinal Surgery, LLC | Neurological Surgery | 1900 The Exchange, Ne, Suite 600, Marietta, GA 30060 | 2020-06-15 |
| 1407477193 | Michael Cynil Daniel | Counselor | 698 N Marietta, Pkwy, Marietta, GA 30060 | 2020-05-04 |
| 1285253401 | Cameron Thomas Kennelly | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne Attn:gme, Marietta, GA 30060 | 2020-04-09 |
| 1922640739 | Jeremiah George Blair | Physician Assistant | 61 Whitcher St Suite 2100, Marietta, GA 30060 | 2019-10-14 |
| 1164064945 | Denise Alicia Mick | Registered Nurse | 677 Church St Wellstar Kennestone Hospital, Marietta, GA 30060 | 2019-10-12 |
| 1184283772 | Iora Health Georgia, P.C. | Internal Medicine | 280 Cobb Pkwy Se, Suite 60, Marietta, GA 30060 | 2019-06-07 |
| 1346703212 | Caitlin Virginia Mueller | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne, Attn: Gme, Marietta, GA 30060 | 2019-04-08 |
| 1184187205 | Adero Francis | Student in an Organized Health Care Education/Training Program | Wellstar Kennestone Gme Internal Medicine Clinic, 833 Campbell Hill St Nw, Suite 250, Marietta, GA 30060 | 2019-04-08 |
| 1659832749 | Matthew Mozzo | Student in an Organized Health Care Education/Training Program | 677 Church Street / Lower Level, Gme Department / I.m., Marietta, GA 30060 | 2019-03-29 |
| 1245797430 | La'myia Spentz | Specialist | 109 Anderson St Ne, Suite 608, Marietta, GA 30060 | 2019-02-25 |
| Find all providers in zip 30060 | ||||
| Taxonomy Code | 367H00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Anesthesiologist Assistant |
| An individual certified by the state to perform anesthesia services under the direct supervision of an anesthesiologist. Anesthesiologist Assistants are required to have a bachelor's degree with a premed curriculum prior to entering a two-year anesthesiology assistant program, which is focused upon the delivery and maintenance of anesthesia care as well as advanced patient monitoring techniques. An Anesthesiologist Assistant must work as a member of the anesthesia care team under the direction of a qualified Anesthesiologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114570553 | Diana Ansley Berry | Anesthesiologist Assistant | 531 Roselane St Nw Ste 830, Marietta, GA 30060-6979 | 2019-07-23 |
| 1346638616 | Sowjanya Thalanki Krishna Murthy | Anesthesiologist Assistant | 3440 River Heights Xing Se, Marietta, GA 30067-4500 | 2015-01-08 |
| 1437417250 | Vivian To | Anesthesiologist Assistant | 2204 Whitehall Dr Ne, Marietta, GA 30066-7202 | 2012-04-30 |
| 1053507129 | Adrianne Humphries | Anesthesiologist Assistant | 531 Roselane St Nw Ste 750, Marietta, GA 30060-6975 | 2007-09-21 |
| 1295818250 | Fleet Lester | Anesthesiologist Assistant | 1288 Sweet Bottom Ct Sw, Sw, Marietta, GA 30064-5222 | 2006-10-23 |
| 1730195348 | Thang Thai | Anesthesiologist Assistant | 531 Roselane Street Nw, Suite 750, Marietta, GA 30060-6975 | 2006-08-01 |
| 1346868908 | Megan Grace Zimmerman | Anesthesiologist Assistant | 677 Church St Ne, Marietta, GA 30060-1101 | 2020-07-10 |
| 1740802032 | Noelle Shaw | Anesthesiologist Assistant | 677 Church St Ne, Marietta, GA 30060-1101 | 2020-05-11 |
| 1417506304 | Jake Lane | Anesthesiologist Assistant | 677 Church St Ne, Marietta, GA 30060-1101 | 2019-09-04 |
| 1194372854 | Mackenzie Williams | Anesthesiologist Assistant | 677 Church St Ne, Marietta, GA 30060-1101 | 2019-08-19 |
| Find all providers in MARIETTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.