Provider Demographics
NPI:1285680587
Name:TRI COUNTY MEDICAL
Entity Type:Organization
Organization Name:TRI COUNTY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:H
Authorized Official - Last Name:DEPOL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-990-0510
Mailing Address - Street 1:1775 WOODSTOCK RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2171
Mailing Address - Country:US
Mailing Address - Phone:678-990-0510
Mailing Address - Fax:678-990-0521
Practice Address - Street 1:1775 WOODSTOCK RD
Practice Address - Street 2:SUITE 110
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2171
Practice Address - Country:US
Practice Address - Phone:678-990-0510
Practice Address - Fax:678-990-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities