Provider Demographics
NPI:1013289131
Name:POTTS, TIMOTHY VIRGIL JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:VIRGIL
Last Name:POTTS
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:613 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2856
Mailing Address - Country:US
Mailing Address - Phone:252-413-0720
Mailing Address - Fax:252-413-0854
Practice Address - Street 1:613 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2856
Practice Address - Country:US
Practice Address - Phone:252-413-0720
Practice Address - Fax:252-413-0854
Is Sole Proprietor?:No
Enumeration Date:2012-02-05
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03372363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant