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General NPI Number Information
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NPI Number | 1699813055
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Entity Type | Individual
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Provider Name | MICHAEL R PITTS PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 03/11/2017
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Provider Practice Location Address
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Address Line | 11285 ELKINS RD SUITE D3
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City | ROSWELL
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State | GA
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Zip | 30076-1259
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Country | US
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Telephone | 770-990-7932
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Fax |
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Provider Business Mailing Address
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Address Line | 11285 ELKINS RD SUITE D3
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City | ROSWELL
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State | GA
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Zip | 30076-1259
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Country | US
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Telephone | 770-990-7932
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY001830
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1052
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License Number State | NM
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