| NPI | 1649416074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES T POTTER Owner/Provider 276-679-0800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: VA 0101232468) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy (Licence: VA 0101232468) |
| 207RA0000X Internal Medicine, Adolescent Medicine (Licence: VA 0102201836) | |
| 207RA0000X Internal Medicine, Adolescent Medicine (Licence: VA 0102201378) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: VA 0102201836) | |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2015-09-02 |