Provider Demographics
NPI:1538116553
Name:PITHADIA, JATIN K (MD)
Entity Type:Individual
Prefix:DR
First Name:JATIN
Middle Name:K
Last Name:PITHADIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 MANCHESTER EXPY
Mailing Address - Street 2:SUITE F-4
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6802
Mailing Address - Country:US
Mailing Address - Phone:706-327-7575
Mailing Address - Fax:706-324-2615
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:SUITE F-4
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6802
Practice Address - Country:US
Practice Address - Phone:706-327-7575
Practice Address - Fax:706-324-2615
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA44569207Q00000X
GA044569207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00862111DMedicaid
GA00862111AMedicaid
GAG54167Medicare UPIN
GA08BBVMBMedicare PIN
GA00862111DMedicaid