Healthcare Provider Details

I. General information

NPI: 1992414395
Provider Name (Legal Business Name): TREVOR GRANT STRICKLAND APC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PHARR RD NE STE 605
ATLANTA GA
30305-3469
US

IV. Provider business mailing address

4448 HENDERSON DR
TUCKER GA
30084-7033
US

V. Phone/Fax

Practice location:
  • Phone: 404-235-5982
  • Fax:
Mailing address:
  • Phone: 706-528-7213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPC008794
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: