Healthcare Provider Details

I. General information

NPI: 1841248374
Provider Name (Legal Business Name): ARMSTEAD BERT PRUITT JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RUTLEDGE AVE
CHARLESTON SC
29403-5848
US

IV. Provider business mailing address

200 RUTLEDGE AVE
CHARLESTON SC
29403-5848
US

V. Phone/Fax

Practice location:
  • Phone: 843-722-8472
  • Fax: 843-723-8631
Mailing address:
  • Phone: 843-722-8472
  • Fax: 843-723-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number5297
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: