Provider Demographics
NPI:1396759627
Name:TRION MEDICAL CENTER INC.
Entity type:Organization
Organization Name:TRION MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WOODROW
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-734-2003
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:TRION
Mailing Address - State:GA
Mailing Address - Zip Code:30753-0880
Mailing Address - Country:US
Mailing Address - Phone:706-734-2003
Mailing Address - Fax:706-734-2099
Practice Address - Street 1:701 ALLGOOD ST
Practice Address - Street 2:
Practice Address - City:TRION
Practice Address - State:GA
Practice Address - Zip Code:30753-1357
Practice Address - Country:US
Practice Address - Phone:706-734-2003
Practice Address - Fax:706-734-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2663Medicare ID - Type Unspecified