Provider Demographics
NPI:1013991249
Name:PITTMAN, HOUSTON HARRIS (MD)
Entity type:Individual
Prefix:
First Name:HOUSTON
Middle Name:HARRIS
Last Name:PITTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 MEMORIAL DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720
Mailing Address - Country:US
Mailing Address - Phone:706-529-9630
Mailing Address - Fax:706-529-9631
Practice Address - Street 1:1107 MEMORIAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8668
Practice Address - Country:US
Practice Address - Phone:706-529-9630
Practice Address - Fax:706-529-9631
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018065207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00698252OtherRR MEDICARE
GA00082541DMedicaid
GAP00698252OtherRR MEDICARE
GAD30477Medicare UPIN