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

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

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

Active since October 02, 2023CLIA 11D2310416 · Waiver

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: August 02, 2026.

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

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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 holds a CLIA Waiver certificate valid through September 3, 2026 and 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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2310416

Trident Primary Care And Wellness · Roswell, GA

Active · expires Sep 3, 2026

CLIA Number11D2310416

Laboratory TypePhysician Office

Certificate Effective DateSeptember 4, 2024

Certificate Expiration DateSeptember 3, 2026

Laboratory DirectorDr. Candace Walker

Laboratory Phone(678) 731-7000

Laboratory LocationTrident Primary Care And Wellness875 Old Roswell Road, Suite B-100, Roswell, GA 30076

CLIA data matches this NPI record on: Address Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PHARMACY HOME DELIVERY

Durable Medical Equipment & Medical Supplies

875 OLD ROSWELL RD, SUITE A700
ROSWELL, GA 30076

Fulton County (770) 594-8288

DR. JOHN PAUL ZURAS JR. D.C.

Chiropractor

875 OLD ROSWELL RD, # A-300
ROSWELL, GA 30076

Fulton County (770) 641-7667

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.

Does Trident Primary Care & Wellness Clinic LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2310416) is associated with this NPI, valid through September 3, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Trident Primary Care & Wellness Clinic LLC accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Trident Primary Care & Wellness Clinic LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

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.