MEDICARE: KELVIN ANDREW PITTMAN JR. DPT

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	225100000X	Physical Therapist	PT017019	GA

General Provider Information

NPI Number	:	1174389944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELVIN ANDREW PITTMAN JR. DPT

Provider Business Mailing Address
First Line	:	1551 HEATHERMOOR WAY
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-7255
Country	:	US
Telephone Number	:	678-739-6374
Fax Number	:

Provider Business Practice Location Address
First Line	:	3605 BRASELTON HWY STE 101
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-4666
Country	:	US
Telephone Number	:	770-904-0772
Fax Number	:

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

Provider Enumeration Date	:	02/28/2024
Last Update Date	:	02/16/2026

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