Provider Demographics
NPI:1215303367
Name:PRUITT, JUSTIN (DO, MS)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:PRUITT
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5575 HIGHWAY 431 S
Mailing Address - Street 2:STE 104
Mailing Address - City:BROWNSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35741-9755
Mailing Address - Country:US
Mailing Address - Phone:256-469-6487
Mailing Address - Fax:
Practice Address - Street 1:5575 HIGHWAY 431 S
Practice Address - Street 2:STE 104
Practice Address - City:BROWNSBORO
Practice Address - State:AL
Practice Address - Zip Code:35741-9755
Practice Address - Country:US
Practice Address - Phone:256-469-6487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.1694207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine