Healthcare Provider Details

I. General information

NPI: 1134539679
Provider Name (Legal Business Name): SAMUEL CASEY PITTS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MAIN ST
THOMSON GA
30824-2662
US

IV. Provider business mailing address

811 13TH ST STE 20
AUGUSTA GA
30901-2771
US

V. Phone/Fax

Practice location:
  • Phone: 706-722-3401
  • Fax:
Mailing address:
  • Phone: 706-722-3401
  • Fax: 706-434-6278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number76414
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: