Healthcare Provider Details

I. General information

NPI: 1164501466
Provider Name (Legal Business Name): J. RANDALL PITTS, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 MEDICAL CENTER DR
CLANTON AL
35045-2331
US

IV. Provider business mailing address

109 MEDICAL CENTER DR
CLANTON AL
35045-2331
US

V. Phone/Fax

Practice location:
  • Phone: 205-755-2296
  • Fax: 205-755-9378
Mailing address:
  • Phone: 205-755-2296
  • Fax: 205-755-9378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number5420
License Number StateAL

VIII. Authorized Official

Name: JAMES RANDALL PITTS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 205-755-2296