Provider Demographics
NPI:1063605228
Name:STARNES, AUTUMN MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:AUTUMN
Middle Name:MARIE
Last Name:STARNES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:AUTUMN
Other - Middle Name:MARIE
Other - Last Name:POTARACKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5542 BURWELL ROAD
Mailing Address - Street 2:
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293-5919
Mailing Address - Country:US
Mailing Address - Phone:276-220-9149
Mailing Address - Fax:949-862-3723
Practice Address - Street 1:143 WOODLAND DR SW
Practice Address - Street 2:
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293-4623
Practice Address - Country:US
Practice Address - Phone:276-365-8071
Practice Address - Fax:949-862-3723
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202850207N00000X, 207N00000X
OH58.002392207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology