MEDICARE: MR. CHARLES B PRUITT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TP2701X	Group Psychotherapy Psychologist
2	104100000X	Social Worker
3	1041C0700X	Clinical Social Worker
4	106H00000X	Marriage & Family Therapist
5	106S00000X	Behavior Technician
6	101Y00000X	Counselor
7	101YA0400X	Addiction (Substance Use Disorder) Counselor
8	101YM0800X	Mental Health Counselor
9	101YP2500X	Professional Counselor
10	103K00000X	Behavior Analyst
11	103TM1800X	Intellectual & Developmental Disabilities Psychologist
12	103TA0400X	Addiction (Substance Use Disorder) Psychologist
13	103TP0016X	Prescribing (Medical) Psychologist
14	103TA0700X	Adult Development & Aging Psychologist
15	103TB0200X	Cognitive & Behavioral Psychologist

General Provider Information

NPI Number	:	1437398799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES B PRUITT

Provider Business Mailing Address
First Line	:	4061 N HENRY BLVD
Second Line	:	SUITE E
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281
Country	:	US
Telephone Number	:	404-629-7378
Fax Number	:

Provider Business Practice Location Address
First Line	:	6191 CROOKED CREEK DR
Second Line	:
City	:	REX
State	:	GA
Zip	:	30273-5008
Country	:	US
Telephone Number	:	404-414-3664
Fax Number	:

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

Provider Enumeration Date	:	02/10/2009
Last Update Date	:	04/22/2024

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Directions to “ MR. CHARLES B PRUITT ” Practice Location

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