Individual
NICHOLAS MARTIN POTISEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 GROVE RD FL 5, GREENVILLE, SC 29605-4210
(864) 455-4411
(864) 455-4480
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
2013-00520
NC
208000000X
Pediatrics Physician
Primary
83351
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q0052Y
—
SC
Enumeration date
05/14/2010
Last updated
05/20/2021
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