Provider Demographics
NPI:1922310044
Name:PITTS, JESSICA ANN (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANN
Last Name:PITTS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:310 PAPER TRAIL WAY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-5203
Mailing Address - Country:US
Mailing Address - Phone:770-345-2804
Mailing Address - Fax:678-827-0927
Practice Address - Street 1:310 PAPER TRAIL WAY
Practice Address - Street 2:SUITE 302
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-5203
Practice Address - Country:US
Practice Address - Phone:770-345-2804
Practice Address - Fax:678-827-0927
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
09494225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist