Provider Demographics
NPI:1093129975
Name:TRUITT, MARY YOUNG (DO)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:YOUNG
Last Name:TRUITT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E HOSPITAL RD
Mailing Address - Street 2:2F-16
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5741
Mailing Address - Country:US
Mailing Address - Phone:706-787-6945
Mailing Address - Fax:
Practice Address - Street 1:300 E HOSPITAL ROAD
Practice Address - Street 2:TRANSITIONAL INTERNSHIP, DDEAMC
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-1648
Practice Address - Fax:706-787-1745
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA75694207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine