Individual
CAROLANNE RUTH PITTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1715 FRIENDSHIP CIR STE 300, CUMMING, GA 30028-6920
(770) 240-0163
Mailing address
3 HARRIER DR, DAWSONVILLE, GA 30534-3661
(678) 956-4478
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SJNB057W9221
ANTHEM
GA
Enumeration date
09/06/2022
Last updated
09/06/2022
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