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NPI Code Detail

MEDICARE: DR. KENNETH G PITTMAN M.D.

MEDICARE: DR. KENNETH G PITTMAN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician47625TN
22084P0800XPsychiatry Physician47625TN
32084P0800XPsychiatry Physician66619GA
42084P0804XChild & Adolescent Psychiatry Physician66619GA
52084P0804XChild & Adolescent Psychiatry Physician47625TN

General Provider Information

NPI Number : 1588822431
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH G PITTMAN M.D.
Provider Business Mailing Address
First Line : 1360 MACKEY BRANCH DR
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-3225
Country : US
Telephone Number : 423-443-3336
Fax Number :
Provider Business Practice Location Address
First Line : 1360 MACKEY BRANCH DR
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-3225
Country : US
Telephone Number : 423-443-3336
Fax Number : 423-464-7510
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2008
Last Update Date : 01/05/2023

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