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General NPI Number Information
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NPI Number | 1912609504
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Entity Type | Organization
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Legal Business Name | TRINITY PRIMARY CARE LLC
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 123 WEAVER RD STE A
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-3155
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Country | US
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Telephone | 706-970-4599
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Fax |
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Provider Business Mailing Address
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Address Line | 123 WEAVER RD STE A
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-3155
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Country | US
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Telephone | 706-970-4599
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Fax |
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Authorized Official
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Title or Position | OWNER/NP
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Name | JACLYN COLLINS
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Credential | NP
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Telephone | 706-400-8675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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