Provider Demographics
NPI:1578803862
Name:PITTS, ANDREA RAY (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:RAY
Last Name:PITTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LAUREN
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 HEALTHY WAY
Mailing Address - Street 2:STE 1200
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-7916
Mailing Address - Country:US
Mailing Address - Phone:864-716-6140
Mailing Address - Fax:
Practice Address - Street 1:100 HEALTHY WAY STE 1200
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-7916
Practice Address - Country:US
Practice Address - Phone:864-260-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL35386207Q00000X
SC35386207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC353860Medicaid
SCSC79227043Medicare PIN