Provider Demographics
NPI:1164707220
Name:TRIVEDI, TRAN B (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:TRAN
Middle Name:B
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:TRAN
Other - Middle Name:B
Other - Last Name:TRINH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:7467 STEVEN PL
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-7251
Mailing Address - Country:US
Mailing Address - Phone:404-457-7989
Mailing Address - Fax:
Practice Address - Street 1:310 GOLD CREEK TRL
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-5435
Practice Address - Country:US
Practice Address - Phone:770-771-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA188936363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care