Healthcare Provider Details

I. General information

NPI: 1770582140
Provider Name (Legal Business Name): RONALD EDWARD PRUITT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 HARDING ROAD SUITE 309 MEDICAL PLAZA WEST
NASHVILLE TN
37205-2013
US

IV. Provider business mailing address

104 WOODMONT BLVD SUITE LL50
NASHVILLE TN
37205-2245
US

V. Phone/Fax

Practice location:
  • Phone: 615-383-0165
  • Fax: 615-292-4657
Mailing address:
  • Phone: 615-386-2361
  • Fax: 615-386-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD0000019680
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: