Provider Demographics
NPI:1134187925
Name:POTTS, JANELLE LEIGH (MD)
Entity type:Individual
Prefix:DR
First Name:JANELLE
Middle Name:LEIGH
Last Name:POTTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JANELLE
Other - Middle Name:LEIGH
Other - Last Name:JOHNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:613 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-6611
Mailing Address - Country:US
Mailing Address - Phone:479-878-1060
Mailing Address - Fax:479-878-1070
Practice Address - Street 1:613 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-6611
Practice Address - Country:US
Practice Address - Phone:479-878-1060
Practice Address - Fax:479-878-1070
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARH65240Medicare UPIN
AR150039001Medicaid
AR5M556Medicare ID - Type Unspecified