Provider Information for 1477076099
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COREY PITTS
Sex: Male
NPI: 1477076099
Last Updated: 2017-07-25
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1477076099 | ||||||||
| Enumeration Date | 2017-07-25 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 515 CLANTON RD CHARLOTTE, NC 28217-1309 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 1170 FAIRGROVE CHURCH RD HICKORY, NC 28602-9695 United States Phone: 828-464-1172 | Fax: | ||||||||
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