Provider Demographics
NPI:1538340682
Name:POTTER, TIMOTHY ALAN (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ALAN
Last Name:POTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3960 KNIGHT ARNOLD RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-3035
Mailing Address - Country:US
Mailing Address - Phone:901-271-9500
Mailing Address - Fax:901-271-9501
Practice Address - Street 1:4095 AMERICAN WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-8339
Practice Address - Country:US
Practice Address - Phone:901-271-9500
Practice Address - Fax:901-271-9501
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2015-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN46256207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1518264Medicaid
TN103I083412Medicare PIN