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Organization
LOCUST GROVE FAMILY MEDICINE
Active
Organization
LOCUST GROVE FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NIMISHA J TRIVEDI MD (OWNER)
(678) 610-6649
Entity
Organization
Contact information
Practice address
3778 HIGHWAY 42, LOCUST GROVE, GA 30248-3632
(678) 610-6649
(678) 610-6025
Mailing address
3778 HIGHWAY 42, LOCUST GROVE, GA 30248-3632
(678) 610-6649
(678) 610-6025
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
053715
GA
332900000X
Non-Pharmacy Dispensing Site
Primary
053715
GA
Other
Enumeration date
09/28/2006
Last updated
03/14/2016
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