Healthcare Provider Details

I. General information

NPI: 1851391494
Provider Name (Legal Business Name): KENNETH E PITTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 WHITESPORT DR SW SUITE 4
HUNTSVILLE AL
35801-6486
US

IV. Provider business mailing address

185 WHITESPORT DR SW SUITE 4
HUNTSVILLE AL
35801-6486
US

V. Phone/Fax

Practice location:
  • Phone: 256-883-9044
  • Fax: 256-883-0260
Mailing address:
  • Phone: 256-883-9044
  • Fax: 256-883-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number13214
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: