Provider Demographics
NPI:1962147124
Name:POTTS, MELONY C (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:MELONY
Middle Name:C
Last Name:POTTS
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1415 VILLAGESIDE CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4411
Mailing Address - Country:US
Mailing Address - Phone:720-636-3643
Mailing Address - Fax:
Practice Address - Street 1:5450 PEACHTREE PKWY STE 2E
Practice Address - Street 2:ATTN: MELONY POTTS #130
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092
Practice Address - Country:US
Practice Address - Phone:720-636-3643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist