Provider Demographics
NPI:1891380960
Name:TRIMBLE, TRINARDRA (CPT)
Entity Type:Individual
Prefix:
First Name:TRINARDRA
Middle Name:
Last Name:TRIMBLE
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 NATHAN DEAN BLVD.
Mailing Address - Street 2:STE. 105 #70
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132
Mailing Address - Country:US
Mailing Address - Phone:404-428-8129
Mailing Address - Fax:
Practice Address - Street 1:413 LANIER CT
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2073
Practice Address - Country:US
Practice Address - Phone:404-428-8129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-01
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAM3W9Y9E6246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy