Individual
DR. JEFFREY N POTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
805 HALL ST, WIGGINS, MS 39577-2110
(601) 928-4412
(601) 579-5240
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 579-5400
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23577
MS
207Q00000X
Family Medicine Physician
MD024152E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008570430005
—
PA
05
—
05706756
—
MS
01
—
151890
HIGHMARK BLUE SHIELD
—
01
—
50000729
CAP BLUE CROSS
—
Enumeration date
12/14/2005
Last updated
07/09/2020
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