Healthcare Provider Details

I. General information

NPI: 1144017948
Provider Name (Legal Business Name): VEVIAN ALEXANDRIA LEE PITTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 SHILOH RD E STE 205
ALPHARETTA GA
30005-8375
US

IV. Provider business mailing address

5955 SHILOH RD E STE 205
ALPHARETTA GA
30005-8375
US

V. Phone/Fax

Practice location:
  • Phone: 470-632-3413
  • Fax: 678-658-9094
Mailing address:
  • Phone: 470-632-3413
  • Fax: 678-658-9094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT01653
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: