Provider Demographics
NPI:1295109403
Name:WITTENBERG, DAVID (CCMA, CPT, CET)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WITTENBERG
Suffix:
Gender:M
Credentials:CCMA, CPT, CET
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 TERRY ST
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-1587
Mailing Address - Country:US
Mailing Address - Phone:478-207-7555
Mailing Address - Fax:
Practice Address - Street 1:528 TERRY ST
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-1587
Practice Address - Country:US
Practice Address - Phone:478-207-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-26
Last Update Date:2015-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy