Healthcare Provider Details

I. General information

NPI: 1457416570
Provider Name (Legal Business Name): JOHN JOSEPH TRIMBLE III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 11/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 COBB PKWY NW
ACWORTH GA
30101
US

IV. Provider business mailing address

1825 MARTHA BERRY BLVD NW
ROME GA
30165-1625
US

V. Phone/Fax

Practice location:
  • Phone: 770-974-3911
  • Fax: 770-405-0606
Mailing address:
  • Phone: 706-295-5331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number030231
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: