Individual
TIFFANY LYNNETTE PRUITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
250 GEORGIA AVE SE STE 206, ATLANTA, GA 30312-3000
(404) 653-0374
Mailing address
4032 PINE MANOR DR, DOUGLASVILLE, GA 30134-2923
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN219329
GA
Other
Enumeration date
04/26/2018
Last updated
04/26/2018
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