Healthcare Provider Details

I. General information

NPI: 1467640219
Provider Name (Legal Business Name): MARY PITCHER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 CHURCH ST NE
MARIETTA GA
30060-1358
US

IV. Provider business mailing address

574 CHURCH ST NE
MARIETTA GA
30060-1358
US

V. Phone/Fax

Practice location:
  • Phone: 770-427-0285
  • Fax: 678-564-1033
Mailing address:
  • Phone: 770-427-0285
  • Fax: 678-564-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number035310
License Number StateGA

VIII. Authorized Official

Name: DR. MARY PITCHER
Title or Position: OWNER
Credential: MD
Phone: 770-427-0285