Provider Demographics
NPI:1700518800
Name:TRUEH, SERINA
Entity Type:Individual
Prefix:
First Name:SERINA
Middle Name:
Last Name:TRUEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1557 BUFORD DR UNIT 490683
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-3718
Mailing Address - Country:US
Mailing Address - Phone:470-783-0291
Mailing Address - Fax:
Practice Address - Street 1:1152 WICKER OAK DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-1612
Practice Address - Country:US
Practice Address - Phone:678-613-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHCP011537251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health