Provider Demographics
NPI:1326425778
Name:POTTS, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:POTTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3937 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUITE 200 AND SUITE 201
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2290
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3937 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE 200 AND SUITE 201
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-2290
Practice Address - Country:US
Practice Address - Phone:855-850-0274
Practice Address - Fax:678-288-7836
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004426133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered