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General NPI Number Information
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NPI Number | 1346298262
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Entity Type | Individual
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Provider Name | JIMMY DANIEL PRUITT MD
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Gender | Male
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 1968 PEACHTREE RD NW
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City | ATLANTA
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State | GA
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Zip | 30309-1281
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Country | US
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Telephone | 404-605-3580
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Fax |
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Provider Business Mailing Address
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Address Line | 5610 BETHELVIEW RD STE 500A
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City | CUMMING
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State | GA
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Zip | 30040-7530
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Country | US
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Telephone | 770-205-2804
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Fax | 770-205-2854
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 029758
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 029758
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License Number State | GA
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