Provider Demographics
NPI:1780827071
Name:PITTMAN, MARIE C (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:C
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:30 RACQUET CLUB PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-6185
Mailing Address - Country:US
Mailing Address - Phone:205-971-1620
Mailing Address - Fax:205-971-1601
Practice Address - Street 1:120 CAHABA VALLEY PKWY STE 203
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-1187
Practice Address - Country:US
Practice Address - Phone:205-985-9828
Practice Address - Fax:205-969-0971
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2024-01-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN47912207Q00000X
LA205815207Q00000X
AL34254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2317482Medicaid
LA2317482Medicaid