MEDICARE: SUBRENA PITTS CNA

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
1	343900000X	Non-emergency Medical Transport (VAN)	130149	GA

General Provider Information

NPI Number	:	1790184224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUBRENA PITTS CNA

Provider Business Mailing Address
First Line	:	118 PLUM ST
Second Line	:	2717 VILLAGE GREEN LANE
City	:	GRAY
State	:	GA
Zip	:	31032-4327
Country	:	US
Telephone Number	:	478-978-5626
Fax Number	:	478-986-4890

Provider Business Practice Location Address
First Line	:	118 PLUM ST
Second Line	:	2717 VILLAGE GREEN LANE
City	:	GRAY
State	:	GA
Zip	:	31032-4327
Country	:	US
Telephone Number	:	478-978-5626
Fax Number	:	478-986-4890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2014
Last Update Date	:	08/20/2014

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