Individual
TERA PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6191 CROOKED CREEK DR, REX, GA 30273-5008
(404) 574-3091
Mailing address
6191 CROOKED CREEK DR, REX, GA 30273-5008
(404) 574-3091
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/29/2016
Last updated
03/29/2016
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