OrganizationActive
Locust Grove Family Medicine
NPI 1629169164 · Non-Pharmacy Dispensing Site · Locust Grove, GA
Provider details
- NPI number
- 1629169164
- Entity type
- Organization
- Primary specialty
- Non-Pharmacy Dispensing SiteSuppliers
- Organization subpart
- No
- Authorized official
- Nimisha Trivedi, Owner(678) 610-6649
- License
- 053715 (GA)
Specialties & taxonomies
Suppliers
Allopathic & Osteopathic Physicians
Practice location
3778 Highway 42
Locust Grove, GA 30248-3632
Phone: (678) 610-6649
Fax: (678) 610-6025
Approximate (ZIP-level) locationGet directions
Mailing address
3778 Highway 42
Locust Grove, GA 30248-3632
Registry dates
- Enumerated
- 2006-09-28
- Last updated
- 2016-03-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.