Provider Demographics
NPI:1679014609
Name:POTTER, GUNA
Entity Type:Individual
Prefix:
First Name:GUNA
Middle Name:
Last Name:POTTER
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 1:6531 E WINDSOR LN
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1374
Mailing Address - Country:US
Mailing Address - Phone:678-768-1177
Mailing Address - Fax:
Practice Address - Street 1:6531 E WINDSOR LN
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1374
Practice Address - Country:US
Practice Address - Phone:678-768-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide