Provider Demographics
NPI:1417123084
Name:BEAU PITTMAN
Entity Type:Organization
Organization Name:BEAU PITTMAN
Other - Org Name:PITTMAN INTERNAL MEDICINE, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:B
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-756-1216
Mailing Address - Street 1:8001 CENTERVIEW PKWY STE 218
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4228
Mailing Address - Country:US
Mailing Address - Phone:901-756-1216
Mailing Address - Fax:901-756-1412
Practice Address - Street 1:8001 CENTERVIEW PKWY STE 218
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4228
Practice Address - Country:US
Practice Address - Phone:901-756-1216
Practice Address - Fax:901-756-1412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty