Individual
LOGAN POTTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
553 THUNDERBOLT ROAD, POPE AAF, NC 28308
(740) 403-9830
Mailing address
2175 REILLY ST, FORT LIBERTY, NC 28310-8526
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
07/19/2023
Last updated
07/19/2023
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