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NPI Code Detail

MEDICARE: JIMMY DANIEL PRUITT MD

MEDICARE: JIMMY DANIEL PRUITT MD
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
1207P00000XEmergency Medicine Physician029758GA
2207Q00000XFamily Medicine Physician029758GA

General Provider Information

NPI Number : 1346298262
Entity Type Code : Individual
Provider Name (Legal Business Name) : JIMMY DANIEL PRUITT MD
Provider Business Mailing Address
First Line : 5610 BETHELVIEW RD STE 500A
Second Line :
City : CUMMING
State : GA
Zip : 30040-7530
Country : US
Telephone Number : 770-205-2804
Fax Number : 770-205-2854
Provider Business Practice Location Address
First Line : 1968 PEACHTREE RD NW
Second Line :
City : ATLANTA
State : GA
Zip : 30309-1281
Country : US
Telephone Number : 404-605-3580
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 11/08/2023

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