Organization
PRUITTHEALTH - JASPER, LLC
Active
Other names
PruittHealth - Jasper
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
1350 E CHURCH ST, JASPER, GA 30143-1910
(706) 253-2441
(706) 253-2453
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
1-112-1663
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00142436A
—
GA
Enumeration date
05/29/2006
Last updated
06/03/2021
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