MEDICARE: MRS. COURTNEY PITTMAN TELARO CST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZS0410X	Surgical Technologist	625684

General Provider Information

NPI Number	:	1033446836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COURTNEY PITTMAN TELARO CST

Provider Business Mailing Address
First Line	:	3280 HOWELL MILL RD NW STE 321
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-4109
Country	:	US
Telephone Number	:	404-946-8323
Fax Number	:

Provider Business Practice Location Address
First Line	:	3280 HOWELL MILL RD NW STE 321
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-4109
Country	:	US
Telephone Number	:	404-946-8323
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2009
Last Update Date	:	01/17/2025

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