Tera Pruitt

Individual provider Active NPI Case Manager/Care Coordinator · Rex, GA

NPI 1073976007 · NPPES record last updated Mar 29, 2016

Key facts

NPI
1073976007
Entity type
Individual (NPI type 1)
Primary specialty
Case Manager/Care Coordinator 171M00000X
Practice address
6191 Crooked Creek Dr
Rex, GA 30273-5008
Phone
(404) 574-3091
NPI assigned
Mar 29, 2016
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X Yes

Addresses

Primary practice location

6191 Crooked Creek Dr
Rex, GA 30273-5008

Mailing address

6191 Crooked Creek Dr
Rex, GA 30273-5008
Phone (404) 574-3091

Other providers in Rex, GA

All providers in Rex, GA · Case Manager/Care Coordinator in Georgia

Sources for this page

Verify at the official NPI Registry.