Provider Demographics
NPI:1770319345
Name:POTTS, CRYSTAL ALANNA
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ALANNA
Last Name:POTTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 EDGEVIEW WAY APT 714
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-1776
Mailing Address - Country:US
Mailing Address - Phone:813-893-1789
Mailing Address - Fax:
Practice Address - Street 1:2000 EDGEVIEW WAY APT 714
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1776
Practice Address - Country:US
Practice Address - Phone:813-893-1789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver