MEDICARE: MADELINE PRUITT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1245957224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE PRUITT

Provider Business Mailing Address
First Line	:	1488 BROOK VALLEY LN NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-3264
Country	:	US
Telephone Number	:	812-629-6321
Fax Number	:

Provider Business Practice Location Address
First Line	:	1488 BROOK VALLEY LN NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-3264
Country	:	US
Telephone Number	:	812-629-6321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2022
Last Update Date	:	10/20/2022

Similar Medicare Providers

1972220952 — ALEXANDRA KRUGER
Practice Location Address:

1488 BROOK VALLEY LN NE
ATLANTA, GA
30324-3264

Practice Phone: 715-817-6961
Practice Fax:

1942231378 — MATRIX REHABILITATION - GEORGIA, INC.
Practice Location Address:

4325 ATLANTA HWY , SUITE 15
LOGANVILLE, GA
30052-3264

Practice Phone: 770-466-3100
Practice Fax: 770-466-3105

1164549556 — LINDSEY SLAUGHTER
Practice Location Address:

3264 CLIFTON RD
ATLANTA, GA
30322-0001

Practice Phone: 404-712-7288
Practice Fax:

1154281848 — INDEPENDENT PHYSICAL THERAPY OF GA, LLC
Practice Location Address:

4325 ATLANTA HWY STE 13
LOGANVILLE, GA
30052-3264

Practice Phone: 470-994-9659
Practice Fax:

1518825959 — EMILY ELIZABETH CORNELIUS MSW
Practice Location Address:

5025 OAK PARK CIR NE
ATLANTA, GA
30324-5292

Practice Phone: 863-944-7883
Practice Fax:

1750048849 — JENNIFER NICOLE COOPER PMHNP-BC
Practice Location Address:

1605 CHANTILLY DR NE
ATLANTA, GA
30324-3267

Practice Phone: 404-785-7878
Practice Fax:

Directions to “ MADELINE PRUITT ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.