Healthcare Provider Details

I. General information

NPI: 1720246887
Provider Name (Legal Business Name): TAYLOR S PRUETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 RIVER OAKS DR
CANTON MS
39046
US

IV. Provider business mailing address

2550 FLOWOOD DR STE 402
FLOWOOD MS
39232-9307
US

V. Phone/Fax

Practice location:
  • Phone: 601-376-2832
  • Fax: 601-376-1816
Mailing address:
  • Phone: 601-936-1395
  • Fax: 601-936-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21099
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number21099
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: