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General NPI Number Information
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NPI Number | 1073484150
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Entity Type | Individual
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Provider Name | ALEXIS PRUETT
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Gender | Female
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Dates
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Enumeration Date | 09/13/2025
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Last Update Date | 09/13/2025
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Provider Practice Location Address
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Address Line | 2220 N DRUID HILLS RD NE
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City | BROOKHAVEN
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State | GA
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Zip | 30329-3117
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Country | US
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Telephone | 404-785-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 881 WINDCROFT CIR NW
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City | ACWORTH
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State | GA
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Zip | 30101-3795
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Country | US
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Telephone | 469-693-9773
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WN0002X
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Taxonomy Name | Neonatal Intensive Care Registered Nurse
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License Number | RN326252
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License Number State | GA
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