1356815278 NPI number — NORTH GEORGIA AUTISM FOUNDATION INC

Table of content: DR. TRENT JAMES PITT OD (NPI 1124104344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356815278 NPI number — NORTH GEORGIA AUTISM FOUNDATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH GEORGIA AUTISM FOUNDATION INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356815278
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 OVERVIEW DR STE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUE RIDGE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30513-6687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-455-5183
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 OVERVIEW DR STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUE RIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30513-6687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-455-5183
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2019

Additional Information

Authorized Official

Authorized Official Last Name:
RITCHIE
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
HOKE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
706-455-1986

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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