Provider Demographics
NPI:1336182450
Name:POTTS, GREGORY J (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:POTTS
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-253-1035
Mailing Address - Fax:502-253-1037
Practice Address - Street 1:9420 BROWNSBORO RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-1118
Practice Address - Country:US
Practice Address - Phone:502-426-4264
Practice Address - Fax:502-426-4221
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY30295207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000052203OtherANTHEM BCBS
KY000000052203OtherANTHEM BCBS
KYF77342Medicare UPIN
KY0594301Medicare ID - Type Unspecified