# LOCUST GROVE FAMILY MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629169164
- **Authorized official:** DR. NIMISHA J TRIVEDI MD (OWNER)
- **Authorized official phone:** (678) 610-6649

## Contact information

- **Practice address:** 3778 HIGHWAY 42, LOCUST GROVE, GA 30248-3632
- **Practice address phone:** (678) 610-6649
- **Practice address fax:** (678) 610-6025
- **Mailing address:** 3778 HIGHWAY 42, LOCUST GROVE, GA 30248-3632
- **Mailing address phone:** (678) 610-6649
- **Mailing address fax:** (678) 610-6025

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 053715 | GA | — |
| 332900000X | Non-Pharmacy Dispensing Site | 053715 | GA | Yes |

## Other

- **Enumeration date:** 09/28/2006
- **Last updated:** 03/14/2016