Provider Demographics
NPI:1871081166
Name:POTTER, MICHELE L (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:POTTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-3300
Mailing Address - Country:US
Mailing Address - Phone:615-599-6868
Mailing Address - Fax:615-599-6988
Practice Address - Street 1:1311 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3300
Practice Address - Country:US
Practice Address - Phone:615-599-6868
Practice Address - Fax:615-599-6988
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN210363A00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease