Provider Demographics
NPI:1720604838
Name:GRESSETTE, KRISTA POTTHAST (MD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:POTTHAST
Last Name:GRESSETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:803-791-2203
Mailing Address - Fax:803-434-4160
Practice Address - Street 1:4540 TRENHOLM RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-4462
Practice Address - Country:US
Practice Address - Phone:803-434-4153
Practice Address - Fax:803-434-4160
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL84509207R00000X
SC84509207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine