Organization
PRUITTHEALTH - LAFAYETTE, LLC
Active
Other names
PruittHealth - Lafayette
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
205 ROADRUNNER BLVD, LA FAYETTE, GA 30728-2161
(706) 638-4662
Mailing address
1626 JEURGENS CT, NORCROSS, GA 30093-2219
(770) 279-6200
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1-146-1721
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00254394A
—
GA
Enumeration date
05/29/2006
Last updated
07/02/2014
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