Provider Demographics
NPI:1477112936
Name:PRUITT, BRIANNA LEE (ATC)
Entity Type:Individual
Prefix:MISS
First Name:BRIANNA
Middle Name:LEE
Last Name:PRUITT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 CAWTHON RD
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-7276
Mailing Address - Country:US
Mailing Address - Phone:706-244-9790
Mailing Address - Fax:
Practice Address - Street 1:2600 HIGHWAY 129 N
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-2710
Practice Address - Country:US
Practice Address - Phone:706-244-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer