Provider Demographics
NPI:1093093759
Name:TRULIANT HEALTH SYSTEMS
Entity Type:Organization
Organization Name:TRULIANT HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARKESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINBAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-722-1622
Mailing Address - Street 1:1400 VETERANS MEMORIAL HWY
Mailing Address - Street 2:STE 134-323
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126
Mailing Address - Country:US
Mailing Address - Phone:770-722-1622
Mailing Address - Fax:866-823-4725
Practice Address - Street 1:526 FOREST PARKWAY STE D
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297
Practice Address - Country:US
Practice Address - Phone:404-565-0181
Practice Address - Fax:866-823-4725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200304940AMedicaid
GA808590OtherWELLCARE