Provider Demographics
NPI:1700974805
Name:TRIVEDI, ABHAY (MD)
Entity Type:Individual
Prefix:DR
First Name:ABHAY
Middle Name:
Last Name:TRIVEDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1459
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031-1459
Mailing Address - Country:US
Mailing Address - Phone:770-491-7030
Mailing Address - Fax:770-491-7144
Practice Address - Street 1:2645 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2502
Practice Address - Country:US
Practice Address - Phone:770-491-7030
Practice Address - Fax:770-491-7144
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA58625207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA126477130AMedicaid
GA126477130BMedicaid
GA06CBBDNMedicare ID - Type Unspecified
GA126477130BMedicaid