Organization
TRIDENT MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHRYN DUPHILY (OPERATIONS MANAGER)
(678) 997-9895
Entity
Organization
Contact information
Practice address
888 OAKDALE RD NE, ATLANTA, GA 30307-1210
(678) 997-9895
Mailing address
888 OAKDALE RD NE, ATLANTA, GA 30307-1210
(678) 997-9895
Taxonomy
Speciality
Code
Description
License number
State
3336M0003X
Managed Care Organization Pharmacy
Primary
—
—
Other
Enumeration date
09/10/2024
Last updated
09/10/2024
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