Provider Demographics
NPI:1174775811
Name:POTTER, BRIAN S (PSYD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:POTTER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 UNION AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6638
Mailing Address - Country:US
Mailing Address - Phone:901-287-5182
Mailing Address - Fax:901-287-6700
Practice Address - Street 1:1211 UNION AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6638
Practice Address - Country:US
Practice Address - Phone:901-287-5182
Practice Address - Fax:901-287-6700
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3108103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist