Basic Information
| Provider Information | |||||||||
| NPI: | 1841242708 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POTTER | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2010 ATHERHOLT RD | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245011106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4342005047 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1901 TATE SPRINGS RD | ||||||||
| Address2: | EMERGENCY DEPT. | ||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245011109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349473027 | ||||||||
| FaxNumber: | 4349473265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 08/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 0101231691 | VA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.