Organization
RELIANCE FAMILY CARE
Active
Parent organization
LOCUST GROVE FAMILY MEDICINE
Organization subpart
Yes
Provider details
NPI number
Legal business name
LOCUST GROVE FAMILY MEDICINE
Authorized official
MRS. NIMISHA J TRIVEDI MD (OWNER)
(678) 610-6649
Entity
Organization
Contact information
Practice address
345 HUNTINGTON PLACE CT, MCDONOUGH, GA 30253-8651
(678) 272-7280
(678) 610-6025
Mailing address
PO BOX 1100, LOCUST GROVE, GA 30248-8651
(678) 610-6649
(678) 610-6025
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
053715
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117518856B
—
GA
Enumeration date
01/21/2009
Last updated
03/03/2011
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