Pittard Clinic LLC

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

Legal business name

PITTARD CLINIC LLC

Practice address

1654 Falls Rd
Toccoa, GA 30577

Phone

(706) 886-4420

Fax

(706) 886-4410

NPI assigned

May 4, 2020

Organization subpart

No

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

Authorized official

Name

Maridan H Pittard

Title

Owner

Phone

(706) 886-4420

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Opioid treatment program

Medicare-enrolled since May 12, 2020

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1588550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588550400000",
    "number": "1912528696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1654 FALLS RD",
            "city": "TOCCOA",
            "state": "GA",
            "postal_code": "30577",
            "telephone_number": "706-886-4420",
            "fax_number": "706-886-4410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1654 FALLS RD",
            "city": "TOCCOA",
            "state": "GA",
            "postal_code": "30577",
            "telephone_number": "706-886-4420",
            "fax_number": "706-886-4410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PITTARD CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-04",
        "last_updated": "2020-05-04",
        "certification_date": "2020-05-04",
        "status": "A",
        "authorized_official_last_name": "PITTARD",
        "authorized_official_first_name": "MARIDAN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-886-4420"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Personal Assistance
• Personal Assistance of Toccoa, LLC
• Persida L Petca, NP-C
• Tara Joy Peters, LMSW
• Elizabeth Williams Pinkerton, M.D.
• Cynthia League Poole, PHYSICAL THERAPIST
• Richard Clayton Power, PT, DPT
• Adrian Nicholas Prather, P.T.
• Natalie Pressley
• Walter Henry Pruitt II, R.PH.

• Methadone Clinic in Toccoa, GA
• Providers in Toccoa, GA by specialty
• Methadone Clinic in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.