Provider Demographics
NPI:1174389944
Name:PITTMAN, KELVIN ANDREW JR (DPT)
Entity type:Individual
Prefix:
First Name:KELVIN
Middle Name:ANDREW
Last Name:PITTMAN
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 HEATHERMOOR WAY
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7255
Mailing Address - Country:US
Mailing Address - Phone:678-739-6374
Mailing Address - Fax:
Practice Address - Street 1:3605 BRASELTON HWY STE 101
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4666
Practice Address - Country:US
Practice Address - Phone:770-904-0772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist