Provider Demographics
NPI:1669494068
Name:PITTS, J W JR (MD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:W
Last Name:PITTS
Suffix:JR
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 1:1130 22ND ST S STE 1000
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2881
Mailing Address - Country:US
Mailing Address - Phone:469-893-2065
Mailing Address - Fax:469-893-3065
Practice Address - Street 1:430 FIELDSTOWN RD STE 104
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071
Practice Address - Country:US
Practice Address - Phone:205-631-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10894207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0515-57148OtherBLUE CROSS
AL0515-57148Medicare ID - Type Unspecified
ALC73907Medicare UPIN