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General NPI Number Information
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NPI Number | 1134974538
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Entity Type | Individual
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Provider Name | NATHANIEL PRUITT
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Gender | Male
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Dates
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Enumeration Date | 04/19/2024
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 1575 CHATTANOOGA AVE STE 1
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City | DALTON
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State | GA
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Zip | 30720-2672
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Country | US
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Telephone | 706-876-2130
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Fax |
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Provider Business Mailing Address
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Address Line | 1608 LEE ST SE
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City | CLEVELAND
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State | TN
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Zip | 37311-3273
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Country | US
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Telephone |
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | GAA-NP004232
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 242649
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License Number State | TN
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