Organization
TRIDENT MEDICAL GROUP PA
Active
Organization
TRIDENT MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEVION SMITH (DIRECTOR, PAYER CONTRACTING)
(424) 326-8711
Entity
Organization
Contact information
Practice address
3372 PEACHTREE ROAD, SUITE 115, ATLANTA, GA 30326
(855) 770-7771
(415) 808-6405
Mailing address
382 NE 191ST ST, PMB 75481, MIAMI, FL 33179-3899
(310) 626-0149
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
213E00000X
Podiatrist
—
—
213EP0504X
Public Medicine Podiatrist
—
—
Other
Enumeration date
12/27/2021
Last updated
11/14/2022
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