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General NPI Number Information
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NPI Number | 1437383247
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Entity Type | Organization
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Legal Business Name | JUANITA G TRIMOR MD PC
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Dates
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Enumeration Date | 05/07/2009
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 1232 AUGUSTA WEST PKWY
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City | AUGUSTA
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State | GA
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Zip | 30909-1854
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Country | US
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Telephone | 706-228-2597
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Fax | 706-228-2598
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Provider Business Mailing Address
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Address Line | 1232 AUGUSTA WEST PKWY
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City | AUGUSTA
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State | GA
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Zip | 30909-1854
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Country | US
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Telephone | 706-228-2597
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Fax | 706-228-2598
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JUANITA G TRIMOR
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Credential | MD
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Telephone | 706-228-2597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 040579
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License Number State | GA
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