Provider Demographics
NPI: | 1477940914 |
---|---|
Name: | ANDREW POTTER LLC |
Entity Type: | Organization |
Organization Name: | ANDREW POTTER LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ANDREW |
Authorized Official - Middle Name: | P |
Authorized Official - Last Name: | POTTER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 770-740-9200 |
Mailing Address - Street 1: | 6495 SHILOH RD |
Mailing Address - Street 2: | STE A2-110 |
Mailing Address - City: | ALPHARETTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30005-1635 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 770-740-9200 |
Mailing Address - Fax: | 770-752-5607 |
Practice Address - Street 1: | 6495 SHILOH RD |
Practice Address - Street 2: | STE A2-110 |
Practice Address - City: | ALPHARETTA |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30005-1635 |
Practice Address - Country: | US |
Practice Address - Phone: | 770-740-9200 |
Practice Address - Fax: | 770-752-5607 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-04-22 |
Last Update Date: | 2015-04-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | CHIR008522 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |