Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 018065 | GA |
NPI | 1013991249 |
---|---|
Provider Name | Houston Harris Pittman |
First Address | Dalton, GA 30720 |
Second Address | Dalton, GA 30720-8668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 24/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00082541D | (05) | GA |
D30477 | (02) | GA |
P00698252 | RR MEDICARE (01) | GA |