Provider Demographics
NPI:1730609843
Name:POTTER, ANTHONY (LMFT, LPC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:POTTER
Suffix:
Gender:M
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3144 PARC CT SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-5206
Mailing Address - Country:US
Mailing Address - Phone:404-849-9906
Mailing Address - Fax:
Practice Address - Street 1:2255 CUMBERLAND PKWY SE
Practice Address - Street 2:BLDG 500; SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-4515
Practice Address - Country:US
Practice Address - Phone:404-592-7928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011271101YP2500X
GAAMT000381106H00000X
GAMFT001668106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003228543AMedicaid