Provider Demographics
NPI:1053619783
Name:POTTER, AMANDA JOHNSON (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JOHNSON
Last Name:POTTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:ERIN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:10721 CHAPMAN HWY
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-4765
Mailing Address - Country:US
Mailing Address - Phone:865-609-1036
Mailing Address - Fax:865-579-2638
Practice Address - Street 1:10721 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-4765
Practice Address - Country:US
Practice Address - Phone:865-609-1036
Practice Address - Fax:865-579-2638
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21594183500000X
TN40741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist