Organization
PRUITTHEALTH - MAGNOLIA MANOR, LLC
Active
Other names
PruittHealth - Magnolia Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NEIL L PRUITT JR. (CHAIRMAN AND CEO)
(770) 279-6200
Entity
Organization
Contact information
Practice address
3003 VETERANS PARKWAY SOUTH, MOULTRIE, GA 31788-6705
(229) 985-3422
(229) 985-0227
Mailing address
1626 JEURGENS CT, NORCROSS, GA 30093-2219
(770) 279-6200
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1-035-1653
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00252007A
—
GA
Enumeration date
05/29/2006
Last updated
06/30/2014
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