Healthcare Provider Details

I. General information

NPI: 1659207959
Provider Name (Legal Business Name): TRUMBALT DYNAMICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GARLINGTON AVE APT 22
WAYCROSS GA
31503-2709
US

IV. Provider business mailing address

2021 N SLAPPEY BLVD # 169
ALBANY GA
31701-1001
US

V. Phone/Fax

Practice location:
  • Phone: 678-879-2819
  • Fax:
Mailing address:
  • Phone: 678-879-2819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AZAUNTTI EDWARDS
Title or Position: ORGANIZER
Credential:
Phone: 678-879-2819