Provider Demographics
NPI:1063129773
Name:PITTMON, IRA LEE
Entity type:Individual
Prefix:MS
First Name:IRA
Middle Name:LEE
Last Name:PITTMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 TARASAVAGE LN
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31705-4371
Mailing Address - Country:US
Mailing Address - Phone:229-903-5400
Mailing Address - Fax:
Practice Address - Street 1:2514 TARASAVAGE LN
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31705-4371
Practice Address - Country:US
Practice Address - Phone:229-903-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor