Provider Demographics
NPI:1598052441
Name:POTTS, GEOFFREY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:ALAN
Last Name:POTTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18100 OAKWOOD BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4085
Mailing Address - Country:US
Mailing Address - Phone:313-240-4900
Mailing Address - Fax:313-429-7992
Practice Address - Street 1:18100 OAKWOOD BLVD STE 300
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4085
Practice Address - Country:US
Practice Address - Phone:313-240-4900
Practice Address - Fax:313-429-7992
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099191207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology