Provider Demographics
NPI:1083614259
Name:PITTMAN, SHOLAH P (MD)
Entity Type:Individual
Prefix:
First Name:SHOLAH
Middle Name:P
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-504-5678
Mailing Address - Fax:
Practice Address - Street 1:2400 MOUNT ZION PKWY
Practice Address - Street 2:KAISER PERMANENTE SOUTHWOOD COMPREHENSIVE MEDICAL CENTE
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2500
Practice Address - Country:US
Practice Address - Phone:770-603-3649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-01-10
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Provider Licenses
StateLicense IDTaxonomies
GA053315207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
58-1397572OtherTAX ID
GA541411884Medicaid
GA541411884Medicaid
58-1397572OtherTAX ID