Individual
CHRISTOPHER M PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-1711
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD.28073
AL
208000000X
Pediatrics Physician
27231
SC
208000000X
Pediatrics Physician
MD.28073
AL
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
27231
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009941851
—
AL
05
—
101785
—
AL
01
—
1942399217
TRICARE SOUTH
AL
01
—
515-40540
BCBS
AL
01
—
515-44055
BCBS
AL
01
—
9287054
AETNA
AL
Enumeration date
10/12/2006
Last updated
07/01/2019
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