Provider Demographics
NPI:1215626791
Name:POTTS, ALLAN TERRILL (PA-C)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:TERRILL
Last Name:POTTS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-7702
Mailing Address - Country:US
Mailing Address - Phone:540-454-5241
Mailing Address - Fax:
Practice Address - Street 1:34 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-7702
Practice Address - Country:US
Practice Address - Phone:540-454-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical