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General NPI Number Information
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NPI Number | 1013245091
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Entity Type | Individual
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Provider Name | LESLIE A PITTMAN MD
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Gender | Female
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Dates
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Enumeration Date | 12/02/2009
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 16741 HWY 67 SUITE A
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City | STATESBORO
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State | GA
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Zip | 30458
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Country | US
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Telephone | 912-623-2391
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Fax | 912-623-2396
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Provider Business Mailing Address
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Address Line | 16741 HWY 67 SUITE A
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City | STATESBORO
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State | GA
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Zip | 30458
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Country | US
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Telephone | 912-623-2391
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Fax | 912-623-2396
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 076411
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License Number State | GA
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