Healthcare Provider Details

I. General information

NPI: 1063450666
Provider Name (Legal Business Name): PRUITTHEALTH HOSPICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 COWART AVE
VALDOSTA GA
31602-2635
US

IV. Provider business mailing address

1626 JEURGENS CT LEGAL DEPT
NORCROSS GA
30093-2219
US

V. Phone/Fax

Practice location:
  • Phone: 229-242-1187
  • Fax: 229-242-0562
Mailing address:
  • Phone: 770-279-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: NEIL L PRUITT JR.
Title or Position: CHAIRMAN AND CEO
Credential:
Phone: 770-925-1143