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General NPI Number Information
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NPI Number | 1790189728
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Entity Type | Organization
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Legal Business Name | CARL C. GITTENS MD PA
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 08/02/2017
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Provider Practice Location Address
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Address Line | 789 SW FEDERAL HWY SUITE 212
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City | STUART
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State | FL
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Zip | 34994-2962
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Country | US
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Telephone | 772-215-5905
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Fax |
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Provider Business Mailing Address
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Address Line | 789 SW FEDERAL HWY SUITE 212
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City | STUART
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State | FL
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Zip | 34994-2962
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARL C. GITTENS
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Credential | M.D.
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Telephone | 772-215-5905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | ME53378
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | ME53378
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License Number State | FL
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