Healthcare Provider Details

I. General information

NPI: 1265137061
Provider Name (Legal Business Name): CHELSEA SMITH PRUITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 BROOKHAVEN DR
ROCKMART GA
30153-7359
US

IV. Provider business mailing address

91 BROOKHAVEN DR
ROCKMART GA
30153-7359
US

V. Phone/Fax

Practice location:
  • Phone: 770-377-9974
  • Fax:
Mailing address:
  • Phone: 770-377-9974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: