Most Relevant Information
Provider Data
| NPI Number: | 1003233727 |
| Provider Name: | MICHELLE PRUITT |
| Entity Type: | Individual |
| Taxonomy Code: | 2255A2300X |
| Specialty: | Specialist/Technologist |
| License Number: | AT0463 |
Most Important Dates
| Enumeration Date: | 03/19/2014 |
| Last Updated: | 03/19/2014 |
Provider Practice Location
4381 S EASON BLVD
TUPELO
MS
388016583
Practice Location Phone/Fax
| Phone: | 6623775468 |
| Fax: |
Provider Mailing Location
4381 S EASON BLVD
TUPELO
MS
388016583
Provider Mailing Phone/Fax
| Phone: | 6623775468 |
| Fax: |