Organization
PRUITTHEALTH - PEAKE, LLC
Active
Other names
PruittHealth - Peake
Organization subpart
No
Provider details
NPI number
Authorized official
NEIL L PRUITT JR. (CHAIRMAN AND CEO OF MANAGER)
(770) 279-6200
Entity
Organization
Contact information
Practice address
6190 PEAKE RD, MACON, GA 31220-3956
(478) 471-7474
Mailing address
1626 JEURGENS CT, LEGAL DEPT, NORCROSS, GA 30093-2219
(770) 279-6200
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1-011-1095
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00143327A
—
GA
Enumeration date
05/29/2006
Last updated
04/05/2021
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