Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 035976 | GA |
NPI | 1467451039 |
---|---|
Provider Name | Dr. Roger Mccoy Pitt |
First Address | Macon, GA 31201-7530 |
Second Address | Macon, GA 31201-7530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 09/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C70943 | (02) | GA |