Provider Demographics
NPI:1982768172
Name:UNIHEALTH SOLUTIONS OF NORTHWEST GEORGIA, INC.
Entity Type:Organization
Organization Name:UNIHEALTH SOLUTIONS OF NORTHWEST GEORGIA, INC.
Other - Org Name:UNIHEALTH SOURCE - ROME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:770-925-1143
Mailing Address - Street 1:39 THREE RIVERS DR NE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-4998
Mailing Address - Country:US
Mailing Address - Phone:706-236-4705
Mailing Address - Fax:
Practice Address - Street 1:39 THREE RIVERS DR NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-4998
Practice Address - Country:US
Practice Address - Phone:706-236-4705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA085500800RMedicaid