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General NPI Number Information
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NPI Number | 1760303952
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Entity Type | Organization
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Legal Business Name | PRUITTHEALTH HOSPICE - TENNESSEE, INC.
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Dates
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Enumeration Date | 07/23/2026
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Last Update Date | 07/23/2026
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Provider Practice Location Address
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Address Line | 34 N LAFAYETTE AVE # 36
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City | BROWNSVILLE
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State | TN
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Zip | 38012-2549
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Country | US
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Telephone | 770-279-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 1626 JEURGENS CT
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City | NORCROSS
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State | GA
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Zip | 30093-2219
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Country | US
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Telephone | 770-279-6200
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Fax |
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT SPECIALIST
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Name | LYNETHIA NYTONYA HOLLEY
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Credential |
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Telephone | 770-806-6875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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