Provider Demographics
NPI:1952361024
Name:PITTS, TIMOTHY E (DPM)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:PITTS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1781
Mailing Address - Country:US
Mailing Address - Phone:229-242-3668
Mailing Address - Fax:229-253-8666
Practice Address - Street 1:2718 N OAK ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1781
Practice Address - Country:US
Practice Address - Phone:229-242-3668
Practice Address - Fax:229-253-8666
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000639213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00484151AMedicaid
GA480013247OtherRAILROAD MEDICARE
GA480014103OtherRAILROAD MEDICARE
GA00484151CMedicaid
GA00484151BMedicaid
GAU26700Medicare UPIN
GA0266960002Medicare NSC
GA480014103OtherRAILROAD MEDICARE
GA00484151CMedicaid
GA48SCBHNMedicare PIN