Organization
PRUITTHEALTH - SEASIDE, LLC
Active
Other names
PruittHealth - Seaside
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
1000 DORSET RD, PORT WENTWORTH, GA 31407-1517
(912) 964-1515
Mailing address
1626 JEURGENS CT, NORCROSS, GA 30093-2219
(770) 279-6200
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00143536A
—
GA
Enumeration date
10/31/2018
Last updated
10/31/2018
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