Provider Demographics
NPI:1477207165
Name:POTTS, FREDERICK SR
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:POTTS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3514 HARBISON CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-1143
Mailing Address - Country:US
Mailing Address - Phone:910-322-3087
Mailing Address - Fax:
Practice Address - Street 1:3514 HARBISON CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-1143
Practice Address - Country:US
Practice Address - Phone:910-322-3087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9866624343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)