Individual
DR. TAYLOR S PRUETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
161 RIVER OAKS DR, CANTON, MS 39046
(601) 376-2832
(601) 376-1816
Mailing address
2550 FLOWOOD DR STE 402, FLOWOOD, MS 39232-9307
(601) 936-1395
(601) 936-1260
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
21099
MS
208M00000X
Hospitalist Physician
21099
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05638761
—
MS
05
—
156867
—
AL
01
—
P01228873
RR MEDICARE PTAN
MS
Enumeration date
05/27/2008
Last updated
01/02/2019
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