Provider Demographics
NPI:1285600064
Name:TRIMBLE, JEFFREY S (PA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:TRIMBLE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NORTHSIDE HOSPITAL- MANAGED CARE DEPT
Mailing Address - Street 2:1000 JOHNSON FERRY RD
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1606
Mailing Address - Country:US
Mailing Address - Phone:404-300-2476
Mailing Address - Fax:404-250-8010
Practice Address - Street 1:2000 HOWARD FARM DR STE 320
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6082
Practice Address - Country:US
Practice Address - Phone:404-847-4180
Practice Address - Fax:404-250-8099
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002532363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA807183998AMedicaid