Provider Demographics
NPI:1699813055
Name:PITTS, MICHAEL R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:PITTS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11285 ELKINS RD
Mailing Address - Street 2:SUITE D3
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1259
Mailing Address - Country:US
Mailing Address - Phone:770-990-7932
Mailing Address - Fax:
Practice Address - Street 1:11285 ELKINS RD
Practice Address - Street 2:SUITE D3
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1259
Practice Address - Country:US
Practice Address - Phone:770-990-7932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2017-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001830103TC0700X
NM1052103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM13938835Medicaid
GA000629978AMedicaid
NMNOT APPLICABLEOtherMESA MENTAL HEALTH
GANPP000Medicare UPIN
NM13938835Medicaid