Provider Demographics
NPI:1841248374
Name:PRUITT, ARMSTEAD BERT JR (MD)
Entity type:Individual
Prefix:DR
First Name:ARMSTEAD
Middle Name:BERT
Last Name:PRUITT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 RUTLEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5848
Mailing Address - Country:US
Mailing Address - Phone:843-722-8472
Mailing Address - Fax:843-723-8631
Practice Address - Street 1:200 RUTLEDGE AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5848
Practice Address - Country:US
Practice Address - Phone:843-722-8472
Practice Address - Fax:843-723-8631
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5297207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC052971Medicaid
SC052971Medicaid