Provider Demographics
NPI:1356113807
Name:PITTS, WESLEY B
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:B
Last Name:PITTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 BEECHWOOD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:STONECREST
Mailing Address - State:GA
Mailing Address - Zip Code:30038-3903
Mailing Address - Country:US
Mailing Address - Phone:404-808-5077
Mailing Address - Fax:
Practice Address - Street 1:4369 SUWANEE DAM RD STE 102
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4646
Practice Address - Country:US
Practice Address - Phone:470-780-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist