Provider Demographics
NPI:1225138456
Name:POTTS, FRED E IV (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:E
Last Name:POTTS
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 MERCY BLVD # 3
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1753
Mailing Address - Country:US
Mailing Address - Phone:912-927-8887
Mailing Address - Fax:912-927-8064
Practice Address - Street 1:11700 MERCY BLVD # 3
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1753
Practice Address - Country:US
Practice Address - Phone:912-927-8887
Practice Address - Fax:912-927-8064
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112571207R00000X
GA075324207R00000X
IL036.135303207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA075324OtherGEORGIA MEDICAL BOARD
GA075324OtherGEORGIA MEDICAL BOARD