Healthcare Provider Details

I. General information

NPI: 1063895837
Provider Name (Legal Business Name): JANNA WILLIAMS-PITTS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 CHEROKEE ST NW
KENNESAW GA
30144-2085
US

IV. Provider business mailing address

805 SANDY PLAINS ROAD MEDICAL STAFF SERVICES
MARIETTA GA
30066-6340
US

V. Phone/Fax

Practice location:
  • Phone: 470-956-3950
  • Fax: 770-565-1830
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20042863A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY004158
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: