Organization
PRUITTHEALTH NUTRITIONAL SUPPLY, INC.
Active
Other names
PruittHealth Nutritional Supply
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NEIL L PRUITT JR. (CHAIRMAN AND CEO)
(770) 279-6200
Entity
Organization
Contact information
Practice address
1626 JEURGENS COURT, NORCROSS, GA 30093-2219
(866) 520-1214
(770) 931-5262
Mailing address
1626 JEURGENS COURT, NORCROSS, GA 30093-2219
(770) 279-6200
(770) 931-5278
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00419031A
—
GA
Enumeration date
05/31/2006
Last updated
04/09/2014
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