=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942248331
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRUITTHEALTH HOME HEALTH - SOUTH ATLANTA, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2006
-----------------------------------------------------
Last Update Date | 10/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7345 RED OAK ROAD BUILDING 25
-----------------------------------------------------
City | UNION CITY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30291-2391
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-254-8573
-----------------------------------------------------
Fax | 770-306-1032
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1626 JEURGENS COURT LEGAL DEPT
-----------------------------------------------------
City | NORCROSS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30093-2219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-279-6200
-----------------------------------------------------
Fax | 770-931-5278
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHAIRMAN AND CEO
-----------------------------------------------------
Name | NEIL L PRUITT JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-279-6200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------