Provider Demographics
NPI:1033253265
Name:PITTS, WARREN MARCUS JR (DO)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:MARCUS
Last Name:PITTS
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 N BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3096
Mailing Address - Country:US
Mailing Address - Phone:706-868-0104
Mailing Address - Fax:706-650-7825
Practice Address - Street 1:393 N BELAIR RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3096
Practice Address - Country:US
Practice Address - Phone:706-868-0104
Practice Address - Fax:706-650-7825
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031177207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000503434AMedicaid
GAGRP2317Medicare ID - Type Unspecified