Healthcare Provider Details

I. General information

NPI: 1588864953
Provider Name (Legal Business Name): ERICA RIVERA-ARMOREDA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 STILESBORO RD NW
KENNESAW GA
30152-7744
US

IV. Provider business mailing address

5150 STILESBORO RD NW STE 120
KENNESAW GA
30152-7741
US

V. Phone/Fax

Practice location:
  • Phone: 678-354-0230
  • Fax:
Mailing address:
  • Phone: 678-354-0230
  • Fax: 678-354-0828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8769
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: