Healthcare Provider Details

I. General information

NPI: 1336359371
Provider Name (Legal Business Name): MORRELL E PRUITTE BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6749 ABINGDON CV
MEMPHIS TN
38119-7805
US

IV. Provider business mailing address

4041 KNIGHT ARNOLD RD
MEMPHIS TN
38118-2128
US

V. Phone/Fax

Practice location:
  • Phone: 901-650-2822
  • Fax:
Mailing address:
  • Phone: 901-821-5600
  • Fax: 901-821-5864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: