Provider Demographics
NPI:1982999421
Name:JACOB, TOBIN POTTAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TOBIN
Middle Name:POTTAS
Last Name:JACOB
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 PEACHTREE PKWY
Mailing Address - Street 2:T-2056
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1048
Mailing Address - Country:US
Mailing Address - Phone:678-965-5806
Mailing Address - Fax:678-965-5806
Practice Address - Street 1:2625 PEACHTREE PKWY
Practice Address - Street 2:T-2056
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1048
Practice Address - Country:US
Practice Address - Phone:678-965-5806
Practice Address - Fax:678-965-5806
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024917183500000X
FLPS46148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist