Provider Demographics
NPI:1245428085
Name:DON L. PRUITT
Entity Type:Organization
Organization Name:DON L. PRUITT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-754-1421
Mailing Address - Street 1:3693 STATE HIGHWAY 60
Mailing Address - Street 2:PO BOX 59
Mailing Address - City:SUCHES
Mailing Address - State:GA
Mailing Address - Zip Code:30572-2921
Mailing Address - Country:US
Mailing Address - Phone:706-747-1421
Mailing Address - Fax:706-747-1423
Practice Address - Street 1:3693 STATE HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:SUCHES
Practice Address - State:GA
Practice Address - Zip Code:30572-2921
Practice Address - Country:US
Practice Address - Phone:706-747-1421
Practice Address - Fax:706-747-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019982208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08OtherMEDICARE PROVIDER ID