Provider Demographics
NPI:1104174523
Name:PITAN, OLUBUNMI TITILOPE (MD)
Entity type:Individual
Prefix:
First Name:OLUBUNMI
Middle Name:TITILOPE
Last Name:PITAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLUBUNMI
Other - Middle Name:TITILOPE
Other - Last Name:ANIBABA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:743 SPRING ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3715
Practice Address - Country:US
Practice Address - Phone:770-219-9000
Practice Address - Fax:770-538-7872
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA074717207R00000X, 208VP0014X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine