Healthcare Provider Details

I. General information

NPI: 1770159428
Provider Name (Legal Business Name): CRYSTAL MARIA RIVERA PEREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 OGLETHORPE AVE STE 200C
ATHENS GA
30606-2165
US

IV. Provider business mailing address

PO BOX 48089
ATHENS GA
30604-8089
US

V. Phone/Fax

Practice location:
  • Phone: 706-389-3875
  • Fax: 706-389-3876
Mailing address:
  • Phone: 706-389-3740
  • Fax: 706-389-3951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number111826
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: