1285600064 NPI number — JEFFREY S. TRIMBLE PA

Table of content: BRIANA FALCON (NPI 1336608975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285600064 NPI number — JEFFREY S. TRIMBLE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRIMBLE
Provider First Name:
JEFFREY
Provider Middle Name:
S.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285600064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NORTHSIDE HOSPITAL- MANAGED CARE DEPT
Provider Second Line Business Mailing Address:
1000 JOHNSON FERRY RD
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30342-1606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-300-2476
Provider Business Mailing Address Fax Number:
404-250-8010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 HOWARD FARM DR STE 320
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMMING
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30041-6082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-847-4180
Provider Business Practice Location Address Fax Number:
404-250-8099
Provider Enumeration Date:
02/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  002532 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 807183998A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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