Provider Demographics
NPI:1376969659
Name:PITTMAN, CHARMEKA
Entity Type:Individual
Prefix:
First Name:CHARMEKA
Middle Name:
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 JONATHAN DR NW APT A
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-4815
Mailing Address - Country:US
Mailing Address - Phone:256-603-6477
Mailing Address - Fax:
Practice Address - Street 1:2216 JONATHAN DR NW APT A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-4815
Practice Address - Country:US
Practice Address - Phone:256-603-6477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16506251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health