Provider Demographics
NPI:1770526691
Name:POTTER, GRAEME (MD)
Entity type:Individual
Prefix:DR
First Name:GRAEME
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1125
Mailing Address - Street 2:
Mailing Address - City:DILLSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28725-1125
Mailing Address - Country:US
Mailing Address - Phone:828-586-6262
Mailing Address - Fax:828-412-4294
Practice Address - Street 1:377 MACKTOWN RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-7627
Practice Address - Country:US
Practice Address - Phone:828-586-6262
Practice Address - Fax:828-412-4294
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00009207V00000X, 208D00000X, 207VG0400X
NC200700009207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7274023OtherCIGNA
NC5907766Medicaid
NC2071530Medicare PIN