Healthcare Provider Details

I. General information

NPI: 1790951192
Provider Name (Legal Business Name): PRUITTHEALTH - NORTH AUGUSTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 TALISMAN DRIVE
NORTH AUGUSTA SC
29841-4032
US

IV. Provider business mailing address

1626 JEURGENS CT
NORCROSS GA
30093-2219
US

V. Phone/Fax

Practice location:
  • Phone: 803-278-2170
  • Fax: 803-442-9344
Mailing address:
  • Phone: 678-533-6485
  • Fax: 770-931-5278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCF721
License Number StateSC

VIII. Authorized Official

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