Individual
TONY SAMUEL POTEAT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1025 VERDAE BLVD, SUITE A, GREENVILLE, SC 29607-4032
(864) 242-4683
(864) 240-8104
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6044
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20978
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110186538
RR MEDICARE
SC
05
—
T51217
—
SC
Enumeration date
12/13/2005
Last updated
04/17/2012
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