Provider Demographics
NPI:1508566787
Name:PITT, MARIE ANGELLA (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ANGELLA
Last Name:PITT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4281 ROYAL MUSTANG WAY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-5912
Mailing Address - Country:US
Mailing Address - Phone:678-865-9667
Mailing Address - Fax:
Practice Address - Street 1:2989 W ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4118
Practice Address - Country:US
Practice Address - Phone:770-932-4614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN258707261QP2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health