Individual
ROSEANN PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, ATC
Contact information
Practice address
1762 CLIFTON RD NE, STE 1650, ATLANTA, GA 30322-4001
(978) 618-7329
Mailing address
169 REDTAIL RD, JEFFERSON, GA 30549-7070
(978) 618-7329
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AT001944
GA
363A00000X
Physician Assistant
—
GA
363AM0700X
Medical Physician Assistant
Primary
9174
GA
Other
Enumeration date
04/28/2015
Last updated
03/10/2019
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