Provider Demographics
NPI:1871370825
Name:PITTS, JOHNNY RAY
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:RAY
Last Name:PITTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 E 211TH ST
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1849
Mailing Address - Country:US
Mailing Address - Phone:216-374-1056
Mailing Address - Fax:
Practice Address - Street 1:374 E 211TH ST
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1849
Practice Address - Country:US
Practice Address - Phone:216-374-1056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker