NPIMap

Organization Active NPI

Potts Pediatrics and Adolescent Medicine and Prevenatative Care LLC

  • Primary Care Clinic/Center
  • Fayetteville, GA
National Provider Identifier
1740501246
Registry record updated Jun 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
17642 Issued in GA
Legal business name
POTTS PEDIATRICS AND ADOLESCENT MEDICINE AND PREVENATATIVE CARE LLC
Practice address
365 N Jeff Davis Dr
Fayetteville, GA 30214-1627
Phone
(770) 461-5003
NPI assigned
Jun 18, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Deborah Staats
Title
Office Administrator
Phone
(770) 461-5003

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 17642 GA Primary

Addresses

Primary practice location

365 N Jeff Davis Dr
Fayetteville, GA 30214-1627

Mailing address

365 N Jeff Davis Dr
Fayetteville, GA 30214-1627
Phone (770) 461-5003

National Provider Directory

National Provider Directory

Locations

1074 Bear Creek Blvd
Hampton, GA 30228

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276819200000",
    "number": "1740501246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 N JEFF DAVIS DR",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141627",
            "telephone_number": "770-461-5003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 N JEFF DAVIS DR",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141627",
            "telephone_number": "770-461-5003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTTS PEDIATRICS AND ADOLESCENT MEDICINE AND PREVENATATIVE CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-18",
        "last_updated": "2010-06-18",
        "status": "A",
        "authorized_official_last_name": "STAATS",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "770-461-5003",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "17642",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.