Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 82710 | GA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 82710 | GA |
NPI | 1154740793 |
---|---|
Provider Name | Kathryn Potter |
First Address | Augusta, GA 30912-0004 |
Second Address | Augusta, GA 30912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2014 |
Last Update Date | 02/10/2020 |