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TRIDENT PRIMARY CARE & WELLNESS CLINIC LLC
NPI 1760262463
Family Medicine in Roswell, GA

Active since October 02, 2023
875 OLD ROSWELL RD, BLDG C, SUITE C-200, ROSWELL, GA 30076(678) 731-7000(678) 731-7005 Get Directions Write a Review

NPPES record last updated: February 7, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Feb 7, 2024, Oct 2, 2023 (2 updates tracked since 2023).

About Trident Primary Care & Wellness Clinic Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TRIDENT PRIMARY CARE & WELLNESS CLINIC LLC (NPI 1760262463) is a healthcare organization registered as a family medicine in Roswell, Georgia and active in the NPI registry since October 2023. The organization lists Roderick Malone, Managing Member, as its authorized official.

NPPES Registry Identity

NPI1760262463
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameTRIDENT PRIMARY CARE & WELLNESS CLINIC LLC
Location Address875 OLD ROSWELL RD, BLDG C, SUITE C-200Roswell, GA 30076-1659
Mailing Address6503 Grand Hickory DrBraselton, GA 30517-6240 · (678) 478-8077
Phone(678) 731-7000
Fax(678) 731-7005
Organization SubpartNo
Authorized OfficialRoderick MaloneManaging Member · (678) 478-8077
Enumeration DateOctober 2, 2023
Last NPPES UpdateFebruary 7, 20242 updates tracked since enumeration
NPPES CertifiedFebruary 7, 2024
✔ NPI 1760262463 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
875 OLD ROSWELL RD, Roswell, GA 30076
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Trident Primary Care & Wellness Clinic Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Trident Primary Care & Wellness Clinic LLC, which bills Medicare for the services they deliver. They are listed nearest first.

Clinicians, nearest first (2)

Candace Walker, M.D.
Family Practice
NPI 1629407549
5610 WENDY BAGWELL PKWY
Hiram, GA 30141
(770) 943-7808
✔ PECOS✔ Accepts Medicare25 mi
Myra Atchison, FNP-BC
Nurse Practitioner
NPI 1992583801
2121 SALEM RD SE
Conyers, GA 30013
(770) 679-4360
✔ PECOS✔ Accepts Medicare34 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Trident Primary Care & Wellness Clinic LLC's NPI number?

The NPI number for Trident Primary Care & Wellness Clinic LLC is 1760262463. It was assigned to this organization in the NPPES registry on October 2, 2023.

Where is Trident Primary Care & Wellness Clinic LLC located?

Trident Primary Care & Wellness Clinic LLC is located at 875 Old Roswell Rd Bldg C, Suite C-200, Roswell, GA 30076. The listed phone number is (678) 731-7000.

What is Trident Primary Care & Wellness Clinic LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Trident Primary Care & Wellness Clinic LLC enrolled in Medicare?

Yes. Trident Primary Care & Wellness Clinic LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Trident Primary Care & Wellness Clinic LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Trident Primary Care & Wellness Clinic LLC, in Family Practice and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Trident Primary Care & Wellness Clinic LLC was last updated on February 7, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.