Laschonda Mindea Pituk, MS, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT00368 Issued in GA

Practice address

27407 Plantation Dr NE
Atlanta, GA 30324-2974

Phone

(404) 906-0642

NPI assigned

Aug 29, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1679055339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27407 PLANTATION DR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303242974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27407 PLANTATION DR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303242974",
            "telephone_number": "404-906-0642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PITUK",
        "first_name": "LASCHONDA",
        "middle_name": "MINDEA",
        "credential": "MS, LAT, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-29",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT00368",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Athletic Trainer in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.