Provider Demographics
NPI:1932750916
Name:TRULY HEALTHCARE SYSTEMS
Entity Type:Organization
Organization Name:TRULY HEALTHCARE SYSTEMS
Other - Org Name:TRULY FAMILY HEALTHCARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATWASSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRULY
Authorized Official - Suffix:
Authorized Official - Credentials:FNPC
Authorized Official - Phone:769-231-7499
Mailing Address - Street 1:PO BOX 743
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-0743
Mailing Address - Country:US
Mailing Address - Phone:601-832-5548
Mailing Address - Fax:
Practice Address - Street 1:1883 HIGHWAY 43 S STE E
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-8406
Practice Address - Country:US
Practice Address - Phone:769-231-7499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-22
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08037351Medicaid