MEDICARE: SHOLAH P PITTMAN MD

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	207V00000X	Obstetrics & Gynecology Physician	C4387	KY
2	207V00000X	Obstetrics & Gynecology Physician	13211	WI
3	207V00000X	Obstetrics & Gynecology Physician	053315	GA
4	207V00000X	Obstetrics & Gynecology Physician	04-51275	KS
5	207V00000X	Obstetrics & Gynecology Physician	ME168489	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	58-1397572	OTHER		TAX ID

General Provider Information

NPI Number	:	1083614259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHOLAH P PITTMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 776351
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6351
Country	:	US
Telephone Number	:	502-588-9490
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 MOUNT ZION PKWY
Second Line	:	KAISER PERMANENTE SOUTHWOOD COMPREHENSIVE MEDICAL CENTE
City	:	JONESBORO
State	:	GA
Zip	:	30236-2500
Country	:	US
Telephone Number	:	770-603-3649
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	10/31/2025

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Directions to “ SHOLAH P PITTMAN MD” Practice Location

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