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General NPI Number Information
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NPI Number | 1124854922
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Entity Type | Organization
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Legal Business Name | TRIDENT MEDICAL GROUP
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Dates
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Enumeration Date | 09/10/2024
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 888 OAKDALE RD NE
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City | ATLANTA
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State | GA
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Zip | 30307-1210
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Country | US
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Telephone | 678-997-9895
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Fax |
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Provider Business Mailing Address
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Address Line | 888 OAKDALE RD NE
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City | ATLANTA
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State | GA
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Zip | 30307-1210
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Country | US
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Telephone | 678-997-9895
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | KATHRYN DUPHILY
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Credential |
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Telephone | 678-997-9895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0003X
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Taxonomy Name | Managed Care Organization Pharmacy
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License Number |
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License Number State |
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