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General NPI Number Information
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NPI Number | 1508566787
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Entity Type | Individual
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Provider Name | MARIE ANGELLA PITT NP
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Gender | Female
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Dates
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Enumeration Date | 03/07/2023
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2989 W ROCK QUARRY RD
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City | BUFORD
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State | GA
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Zip | 30519-4118
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Country | US
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Telephone | 770-932-4614
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Fax |
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Provider Business Mailing Address
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Address Line | 4281 ROYAL MUSTANG WAY
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City | SNELLVILLE
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State | GA
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Zip | 30039-5912
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Country | US
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Telephone | 678-865-9667
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Fax |
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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 | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number | RN258707
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License Number State | GA
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