Provider Demographics
NPI:1326058447
Name:POTTS, SAMUEL ERNEST (DPM)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:ERNEST
Last Name:POTTS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-695-6697
Mailing Address - Fax:
Practice Address - Street 1:340 MEDICAL PKWY STE 250
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-2441
Practice Address - Country:US
Practice Address - Phone:864-797-9480
Practice Address - Fax:864-797-9482
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004684213E00000X, 213ER0200X, 213ES0131X
SC766213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5805819OtherBLUE CROSS BLUE SHIELD
230121OtherHEALTHLINK
480014432OtherPALMETTA GBA-RR MEDICARE
480014432OtherPALMETTA GBA-RR MEDICARE
U42154Medicare UPIN