Provider Demographics
NPI:1932676210
Name:POTTER, CINDY LENEAU
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:LENEAU
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 1:615 GEDDINGS RD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-9625
Mailing Address - Country:US
Mailing Address - Phone:803-406-5855
Mailing Address - Fax:
Practice Address - Street 1:615 GEDDINGS RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-9625
Practice Address - Country:US
Practice Address - Phone:803-406-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC134544E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC$$$$$$$$$Medicaid