Provider Demographics
NPI:1689868622
Name:POTTS, CHARLES EUGENE (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EUGENE
Last Name:POTTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 SNAPDRAGON DR NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-7207
Mailing Address - Country:US
Mailing Address - Phone:606-585-5448
Mailing Address - Fax:
Practice Address - Street 1:4450 W EAU GALLIE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7215
Practice Address - Country:US
Practice Address - Phone:321-751-6671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128442207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024494300Medicaid
DC4419270Medicaid
H27078Medicare UPIN