Don L Pruitt, M.D. PROF.CORP.
Individual provider Active NPI General Practice Physician · Suches, GA
NPI 1194808253 · NPPES record last updated Sep 30, 2013
Key facts
- NPI
- 1194808253
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 019982 (GA)
- Practice address
- 56 Firewater LN
Suches, GA 30572-2941 - Phone
- (706) 747-1421
- Fax
- (706) 747-1423
- NPI assigned
- Oct 23, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019982 | GA | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chatuge Regional Hospital Inc | Past | Accepting new patients | |
| Chatuge Regional Hospital Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 019982 | GA | Yes |
Addresses
Primary practice location
56 Firewater LN
Suches, GA 30572-2941
Mailing address
PO Box 59
Suches, GA 30572-0059
Phone (706) 747-1421
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000192255F | Medicaid | GA |
Other providers in Suches, GA
All providers in Suches, GA · General Practice Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 30, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.