Provider Demographics
NPI:1447943345
Name:TRIMBLE, ALEXIS (CPHT, CMA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:TRIMBLE
Suffix:
Gender:F
Credentials:CPHT, CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6076 VERMILION LOOP
Mailing Address - Street 2:
Mailing Address - City:GRANITEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29829-3258
Mailing Address - Country:US
Mailing Address - Phone:706-294-2141
Mailing Address - Fax:
Practice Address - Street 1:6076 VERMILION LOOP
Practice Address - Street 2:
Practice Address - City:GRANITEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29829-3258
Practice Address - Country:US
Practice Address - Phone:706-294-2141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20-1454Y10246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy