POTTS PEDIATRICS AND ADOLESCENT MEDICINE AND PREVENATATIVE CARE LLC (NPI# 1740501246) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740501246 |
| Entity Type | Organization |
| Organization Name | POTTS PEDIATRICS AND ADOLESCENT MEDICINE AND PREVENATATIVE CARE LLC |
| Practice Address |
365 N Jeff Davis Dr Fayetteville GA 30214-1627 |
| Practice Telephone | 7704615003 |
| Mailing Telephone | 7704615003 |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2010-06-18 |
| Authorized Official Name | MRS. DEBORAH STAATS (OFFICE ADMINISTRATOR) |
| Authorized Official Telephone | 7704615003 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
17642 | GA | Ambulatory Health Care Facilities |
| Street Address |
365 N JEFF DAVIS DR |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214-1627 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841212685 | John M Potts | Pediatrics | 365 N Jeff Davis Dr, Fayetteville, GA 30214 | 2006-07-24 |
| 1225412877 | Rachel J Mussell | Physician Assistant | 365 N Jeff Davis Dr, Fayetteville, GA 30214-1627 | 2015-07-14 |
| 1295011146 | Sarah Emily Cline | Physician Assistant | 365 N Jeff Davis Dr, Fayetteville, GA 30214-1627 | 2011-10-24 |
| 1457510158 | Potts and Smith Pediatrics | Pediatrics | 365 N Jeff Davis Dr, Fayetteville, GA 30214-1627 | 2008-06-06 |
| 1194982371 | Kelly L Tolcher | Nurse Practitioner | 365 N Jeff Davis Dr, Fayetteville, GA 30214-1627 | 2008-05-16 |
| 1205093465 | Ronald T Thompson | Physician Assistant | 365 N Jeff Davis Dr, Fayetteville, GA 30214-1627 | 2008-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
| 1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
| 1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
| 1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
| Find all providers in zip 30214 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568021160 | Brighter Pathway To Healthcare | Clinic/Center | 2641 Cameron Woods Ln Apt Suite, Fayetteville, NC 28306-7700 | 2019-06-07 |
| 1720642770 | Arcare | Clinic/Center | 2894 N Mckee Cir Ste 101, Fayetteville, AR 72703-3498 | 2019-04-25 |
| 1174003685 | Premise Health of Arkansas Medical P A | Clinic/Center | 2907 E Joyce Blvd Ste 6, Fayetteville, AR 72703-5390 | 2018-08-15 |
| 1770004723 | Vita Family Practice Pllc | Clinic/Center | 609 Executive Pl Ste B, Fayetteville, NC 28305-5713 | 2017-06-29 |
| 1083087837 | Cornerstone Family Practice & Urgent Care, Pllc | Clinic/Center | 2547 Ravenhill Dr, Suite 104, Fayetteville, NC 28303-9616 | 2015-11-02 |
| 1609186790 | Stedman - Wade Health Services, Inc | Clinic/Center | 2409 Murchison Rd Ste B, Fayetteville, NC 28301-3519 | 2010-10-07 |
| 1093020240 | Georgia Medical Consultants, P.C. | Clinic/Center | 101 Devant Street, Suite 105, Fayetteville, GA 30214-7636 | 2010-08-12 |
| 1063682227 | Noralean Williams,md,pa | Clinic/Center | 705 Cumberland St, #a, Fayetteville, NC 28301-7020 | 2008-03-04 |
| 1548358526 | Carolina Family Practice Centre,pa | Clinic/Center | 2500 Village Dr Ste 100, Fayetteville, NC 28304-3811 | 2006-10-11 |
| 1841247368 | Five Oaks Family Clinic, Inc. | Clinic/Center | Rr 3 Box 458e, Fayetteville, WV 25840-9589 | 2006-05-29 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 30214 |
Please comment or provide details below to improve the information on POTTS PEDIATRICS AND ADOLESCENT MEDICINE AND PREVENATATIVE CARE LLC.
| 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.