Jerry L Pruitt, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

17415 Issued in NC

Practice address

245 11TH Ave NE
Hickory, NC 28601-3835

Phone

(828) 328-3500

Fax

(828) 328-8777

NPI assigned

May 11, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Piedmont Plastic Surgery and Dermatology

  • Dermatology Physician
  • Shelby, NC
  • NPI 1316056104
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592870400000",
    "number": "1124078274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1072 X RAY DR",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280547488",
            "telephone_number": "704-671-1094",
            "fax_number": "704-671-1095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 11TH AVE NE",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286013835",
            "telephone_number": "828-328-3500",
            "fax_number": "828-328-8777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUITT",
        "first_name": "JERRY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NC",
            "license": "17415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "69390",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8909390",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Stephen Pritchard, OTRL
• Mistie Rhena Pritchard, FNP
• Kali Mackenzie Pritchett
• Professional Sleep Diagnostics
• Shirley P Propst, FNP
• Publix North Carolina LP
• Karen Jones Puett, FNP
• Abby Huffman Pulley, M.ED., LPC, NCC
• Debbie L Punch, LCAS-A
• Gregory Brenton Queen, MS, LMFT, LCAS

• Dermatology Physician in Hickory, NC
• Providers in Hickory, NC by specialty
• Dermatology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.