Provider Demographics
NPI:1356402176
Name:PRUITT, HELKI C (MED CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:HELKI
Middle Name:C
Last Name:PRUITT
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 390924
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-0016
Mailing Address - Country:US
Mailing Address - Phone:770-827-8622
Mailing Address - Fax:770-736-3110
Practice Address - Street 1:4295 BURGOMEISTER PL
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-5905
Practice Address - Country:US
Practice Address - Phone:770-827-8622
Practice Address - Fax:770-736-3110
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005472235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA308949OtherWELLCARE OF GA PROVIDERID
GA10034844OtherAMERIGROUP CORP. PROVI ID