Provider Demographics
NPI:1689564346
Name:PITTMAN, ALEISHA
Entity type:Individual
Prefix:
First Name:ALEISHA
Middle Name:
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 CAMP CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8761
Mailing Address - Country:US
Mailing Address - Phone:803-220-5127
Mailing Address - Fax:888-834-3886
Practice Address - Street 1:88 CAMP CREEK DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8761
Practice Address - Country:US
Practice Address - Phone:803-220-5127
Practice Address - Fax:888-834-3886
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-05
Last Update Date:2025-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental