Provider Demographics
NPI:1871532374
Name:PITTS, ROBERT B (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:PITTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 W BOGGS ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30648-2321
Mailing Address - Country:US
Mailing Address - Phone:706-743-0006
Mailing Address - Fax:706-740-6073
Practice Address - Street 1:219 W BOGGS ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:GA
Practice Address - Zip Code:30648-2321
Practice Address - Country:US
Practice Address - Phone:706-743-0006
Practice Address - Fax:706-740-6073
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA27891207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA497138OtherBLUE CROSS BLUE SHIELD
GA000393126AMedicaid
GA04BDBDKMedicare PIN
GAD42095Medicare UPIN
GA010024023Medicare PIN