Provider Demographics
NPI:1295150373
Name:PITTMON, BRANDI SMITH
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:SMITH
Last Name:PITTMON
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 1:235 VOORHEES RD E
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:GA
Mailing Address - Zip Code:31811-5673
Mailing Address - Country:US
Mailing Address - Phone:706-761-3864
Mailing Address - Fax:
Practice Address - Street 1:235 VOORHEES RD E
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:GA
Practice Address - Zip Code:31811-5673
Practice Address - Country:US
Practice Address - Phone:706-761-3864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor