Organization
PRUITTHEALTH - MOULTRIE, LLC
Active
Other names
PruittHealth - Moultrie
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NEIL L. PRUITT JR. (CHAIRMAN AND CEO OF MANAGER)
(770) 279-6200
Entity
Organization
Contact information
Practice address
233 SUNSET CIRCLE, MOULTRIE, GA 31768-6926
(229) 985-4320
(229) 890-0880
Mailing address
1626 JEURGENS CT, NORCROSS, GA 30093-2219
(770) 279-6200
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
10351980
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00142095A
—
GA
Enumeration date
11/18/2005
Last updated
06/03/2021
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