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General NPI Number Information
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NPI Number | 1245428085
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Entity Type | Organization
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Legal Business Name | DON L. PRUITT
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 3693 STATE HIGHWAY 60
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City | SUCHES
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State | GA
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Zip | 30572-2921
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Country | US
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Telephone | 706-747-1421
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Fax | 706-747-1423
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Provider Business Mailing Address
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Address Line | 3693 STATE HIGHWAY 60 PO BOX 59
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City | SUCHES
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State | GA
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Zip | 30572-2921
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Country | US
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Telephone | 706-747-1421
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Fax | 706-747-1423
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. DON LEE PRUITT
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Credential | MD
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Telephone | 706-754-1421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 019982
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License Number State | GA
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