Basic Information
| Provider Information | |||||||||
| NPI: | 1437286853 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POTTER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 338 COEBURN AVE SW | ||||||||
| Address2: | |||||||||
| City: | NORTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242732606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766790800 | ||||||||
| FaxNumber: | 2766790097 | ||||||||
| Practice Location | |||||||||
| Address1: | 338 COEBURN AVE SW | ||||||||
| Address2: | |||||||||
| City: | NORTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242732606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766792377 | ||||||||
| FaxNumber: | 2766796092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 06/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | 0101232468 | VA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
ID Information
| ID | Type | State | Issuer | Description | 010002761 | 05 | VA | MEDICAID | 208496 | 01 | VA | ANTHEM | OTHER |