Provider Demographics
NPI:1144017948
Name:PITTMAN, VEVIAN ALEXANDRIA LEE
Entity type:Individual
Prefix:
First Name:VEVIAN
Middle Name:ALEXANDRIA LEE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 ATLANTA HWY STE 701
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-1255
Mailing Address - Country:US
Mailing Address - Phone:470-632-3413
Mailing Address - Fax:678-658-9094
Practice Address - Street 1:2450 ATLANTA HWY STE 701
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-1255
Practice Address - Country:US
Practice Address - Phone:470-632-3413
Practice Address - Fax:678-658-9094
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016532251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics