Healthcare Provider Details

I. General information

NPI: 1336686336
Provider Name (Legal Business Name): TRINITY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 S LEROY ST
METTER GA
30439-4631
US

IV. Provider business mailing address

154 S LEROY ST
METTER GA
30439-4631
US

V. Phone/Fax

Practice location:
  • Phone: 912-713-1007
  • Fax: 912-450-0998
Mailing address:
  • Phone: 912-685-2246
  • Fax: 912-685-2248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberRN194174
License Number StateGA

VIII. Authorized Official

Name: JACQUELINE BROWN
Title or Position: PARTNER
Credential: FNP
Phone: 912-713-1007