Healthcare Provider Details

I. General information

NPI: 1871726356
Provider Name (Legal Business Name): DAVID RIVERA FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 01/07/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 STEVE REYNOLDS BLVD KAISER PERMANENTE GWINNETT COMPREHENSIVE MEDICAL CENTER
DULUTH GA
30096-4506
US

IV. Provider business mailing address

3495 PIEDMONT RD NE NINE PIEDMONT CENTER
ATLANTA GA
30305-1717
US

V. Phone/Fax

Practice location:
  • Phone: 770-931-6012
  • Fax: 404-778-5495
Mailing address:
  • Phone: 404-364-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN150700
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: