Organization
PRUITTHEALTH - OLD CAPITOL, LLC
Active
Other names
PruittHealth - Old Capitol
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
310 HIGHWAY 1 BYPASS, LOUISVILLE, GA 30434-6432
(478) 625-3741
(478) 625-9473
Mailing address
1626 JEURGENS CT, LEGAL DEPT, NORCROSS, GA 30093-2219
(678) 533-6485
(770) 931-5278
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1-081-1569
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00142304A
—
GA
Enumeration date
05/29/2006
Last updated
04/07/2021
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