Healthcare Provider Details

I. General information

NPI: 1235186750
Provider Name (Legal Business Name): PRUITTHEALTH-SAVANNAH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2006
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12825 WHITE BLUFF ROAD
SAVANNAH GA
31419-2993
US

IV. Provider business mailing address

1626 JEURGENS COURT
NORCROSS GA
30093-2219
US

V. Phone/Fax

Practice location:
  • Phone: 912-927-9416
  • Fax: 912-927-9956
Mailing address:
  • Phone: 770-279-6200
  • Fax: 706-886-0542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10251652
License Number StateGA

VIII. Authorized Official

Name: NEIL L. PRUITT JR.
Title or Position: CHAIRMAN AND CEO OF MANAGER
Credential:
Phone: 770-279-6200