Healthcare Provider Details

I. General information

NPI: 1760077150
Provider Name (Legal Business Name): TREVOR MCBRIDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17007 HIGHWAY 67
STATESBORO GA
30458-2426
US

IV. Provider business mailing address

210 E DERENNE AVE
SAVANNAH GA
31405-6736
US

V. Phone/Fax

Practice location:
  • Phone: 912-681-2500
  • Fax:
Mailing address:
  • Phone: 912-644-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number113762
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101277453
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: