Organization
PRUITTHEALTH - GRIFFIN, LLC
Active
Other names
PruittHealth - Griffin
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
619 NORTHSIDE DR, GRIFFIN, GA 30223-1402
(770) 228-4517
(770) 412-9145
Mailing address
1626 JEURGENS CT, NORCROSS, GA 30093-2219
(770) 279-6200
(770) 931-5278
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1-126-1395
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00143052A
—
GA
Enumeration date
05/29/2006
Last updated
05/14/2015
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