Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Locust Grove Family Medicine

Organization Family Medicine Physician · NPI 1629169164

Locust Grove Family Medicine provides Family Medicine Physician services in Locust Grove, Georgia. Licensed in Georgia. Registered with an NPI since 2006.

Licensed in
GA
In the registry since
2006
Specialties on file
2

Practice location Address checks out

3778 Highway 42
Locust Grove, GA 30248-3632 Not confirmed with CMS for 10 years — call before visiting
Phone: (678) 610-6649
Fax: (678) 610-6025
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Non-Pharmacy Dispensing Site (primary) Taxonomy 332900000X · Licence 053715 (GA)
Family Medicine Physician Taxonomy 207Q00000X · Licence 053715 (GA)

Record details

NPI number1629169164
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Nimisha Trivedi — Owner · (678) 610-6649
NPI enumeratedSeptember 28, 2006
Last updated in NPPESMarch 14, 2016
Mailing address3778 Highway 42, Locust Grove, GA 30248-3632

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