Healthcare Provider Details

I. General information

NPI: 1477504652
Provider Name (Legal Business Name): PITTS PROFESSIONAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 MARION STREET
COLUMBIA SC
29220-0001
US

IV. Provider business mailing address

1519 MARION STREET
COLUMBIA SC
29220-0001
US

V. Phone/Fax

Practice location:
  • Phone: 803-296-5954
  • Fax: 803-296-3076
Mailing address:
  • Phone: 803-296-5954
  • Fax: 803-296-3076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES R. HUBBARD JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 803-296-5954