Provider Demographics
NPI:1518437987
Name:POTTS, DONITA
Entity Type:Individual
Prefix:
First Name:DONITA
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 1:2651 S DURAND RD
Mailing Address - Street 2:
Mailing Address - City:LENNON
Mailing Address - State:MI
Mailing Address - Zip Code:48449-9719
Mailing Address - Country:US
Mailing Address - Phone:810-516-8609
Mailing Address - Fax:
Practice Address - Street 1:2651 S DURAND RD
Practice Address - Street 2:
Practice Address - City:LENNON
Practice Address - State:MI
Practice Address - Zip Code:48449-9719
Practice Address - Country:US
Practice Address - Phone:810-516-8273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator