Healthcare Provider Details

I. General information

NPI: 1508760810
Provider Name (Legal Business Name): MR. ANTHONY ROY PITTMAN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 STONERIDGE LN
ROCKY MOUNT NC
27804-9640
US

IV. Provider business mailing address

921 JASON CT
ROCKY MOUNT NC
27803-1643
US

V. Phone/Fax

Practice location:
  • Phone: 252-903-6816
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number000038553385
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: