Healthcare Provider Details

I. General information

NPI: 1588822431
Provider Name (Legal Business Name): KENNETH G PITTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 MACKEY BRANCH DR
CHATTANOOGA TN
37421-3225
US

IV. Provider business mailing address

1360 MACKEY BRANCH DR
CHATTANOOGA TN
37421-3225
US

V. Phone/Fax

Practice location:
  • Phone: 423-443-3336
  • Fax: 423-464-7510
Mailing address:
  • Phone: 423-443-3336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47625
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number47625
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number66619
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number66619
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number47625
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: