Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 031177 | GA |
NPI | 1033253265 |
---|---|
Provider Name | Dr. Warren Marcus Pitts JR. |
First Address | Evans, GA 30809-3096 |
Second Address | Evans, GA 30809-3096 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000503434A | (05) | GA |
D80370 | (02) | GA |