Provider Demographics
NPI:1780893602
Name:TRULY, WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:TRULY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1069
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-1069
Mailing Address - Country:US
Mailing Address - Phone:601-829-0018
Mailing Address - Fax:601-829-0944
Practice Address - Street 1:EAST PEACE ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-1069
Practice Address - Country:US
Practice Address - Phone:601-829-0018
Practice Address - Fax:601-829-0944
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS066123208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00019961Medicaid
012920167Medicare ID - Type Unspecified
MS00019961Medicaid