MEDICARE: ANNA C PRUITT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	19626	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	571020809034	OTHER	SC	TRICARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	571020809002	OTHER	SC	BCBS SC

General Provider Information

NPI Number	:	1023057676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA C PRUITT MD

Provider Business Mailing Address
First Line	:	8761 DORCHESTER RD STE 100
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-7320
Country	:	US
Telephone Number	:	843-747-4647
Fax Number	:	843-745-0969

Provider Business Practice Location Address
First Line	:	8761 DORCHESTER RD STE 100
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-7320
Country	:	US
Telephone Number	:	843-747-4647
Fax Number	:	843-745-0969

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	03/16/2026

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