Provider Demographics
NPI:1548592975
Name:JAMES M. POTTS, M.D., APMC
Entity Type:Organization
Organization Name:JAMES M. POTTS, M.D., APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-324-0055
Mailing Address - Street 1:P.O. BOX 1284
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71210-1284
Mailing Address - Country:US
Mailing Address - Phone:318-324-0055
Mailing Address - Fax:318-324-9959
Practice Address - Street 1:312 GRAMMONT ST.
Practice Address - Street 2:SUITE 301
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-324-0055
Practice Address - Fax:318-324-9959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X
LAMD016865208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1933627Medicaid
LA1933627Medicaid
LA5DM85Medicare PIN