Provider Demographics
NPI:1174599419
Name:POTTER, NICHOLAS T (PHD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:T
Last Name:POTTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1103 EDBURY DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-8016
Mailing Address - Country:US
Mailing Address - Phone:865-694-9090
Mailing Address - Fax:
Practice Address - Street 1:250 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5782
Practice Address - Country:US
Practice Address - Phone:865-380-9746
Practice Address - Fax:865-380-9191
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN18203207SG0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular Genetics