Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 10374 | SC |
NPI | 1033139985 |
---|---|
Provider Name | David W Potts |
First Address | Anderson, SC 29622-2047 |
Second Address | Anderson, SC 29621-3334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 28/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103747 | (05) | SC |
C06100 | (02) | SC |