Provider Demographics
NPI:1083716682
Name:POTEET-JOHNSON, DEBORAH (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:POTEET-JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:JOANNE
Other - Last Name:POTEET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:105 LEE PARKWAY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-6708
Mailing Address - Country:US
Mailing Address - Phone:423-855-9991
Mailing Address - Fax:423-855-4262
Practice Address - Street 1:105 LEE PARKWAY DR
Practice Address - Street 2:SUITE A
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6708
Practice Address - Country:US
Practice Address - Phone:423-855-9991
Practice Address - Fax:423-855-4262
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD16576174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA198054324AMedicaid
TN270029166OtherTAX ID
TN3825543Medicaid
TN4051818OtherBLUE CROSS BLUE SHIELD TN
TN4051818OtherBLUECARE
TN4051818OtherTENNCARE SELECT
GA000790655AMedicaid
TN4051818OtherBLUECARE
TN3825543Medicaid