Provider Demographics
NPI:1609882844
Name:POTTS, CARL R (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:R
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:PO BOX 751137
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1137
Mailing Address - Country:US
Mailing Address - Phone:866-448-1640
Mailing Address - Fax:
Practice Address - Street 1:730 STONY LANDING RD
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461
Practice Address - Country:US
Practice Address - Phone:843-797-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14480207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG34689Medicaid
E97185Medicare UPIN
SCE971855872Medicare ID - Type Unspecified
SCAA38082987Medicare PIN
SCAA38082986Medicare PIN