Provider Demographics
NPI:1679090922
Name:POTERACKI, JEFFREY D
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:POTERACKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 UNION HILL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2064
Mailing Address - Country:US
Mailing Address - Phone:205-812-4331
Mailing Address - Fax:
Practice Address - Street 1:400 UNION HILL DR STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-2064
Practice Address - Country:US
Practice Address - Phone:205-812-4331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic