Provider Demographics
NPI:1720105315
Name:TOWN AND COUNTRY DERMATOLOGY
Entity Type:Organization
Organization Name:TOWN AND COUNTRY DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-832-2009
Mailing Address - Street 1:2470 DANIELS BRIDGE RD
Mailing Address - Street 2:SUITE 261
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6187
Mailing Address - Country:US
Mailing Address - Phone:706-353-4570
Mailing Address - Fax:706-353-4036
Practice Address - Street 1:2470 DANIELS BRIDGE RD
Practice Address - Street 2:SUITE 261
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6187
Practice Address - Country:US
Practice Address - Phone:706-353-4570
Practice Address - Fax:706-353-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029364207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty