Healthcare Provider Details

I. General information

NPI: 1780144956
Provider Name (Legal Business Name): RIUYINOSA ELEMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 HOSPITAL DRIVE BUILDING A, SUITE 430
MACON GA
31217
US

IV. Provider business mailing address

380 HOSPITAL DRIVE BUILDING A, SUITE 430
MACON GA
31217
US

V. Phone/Fax

Practice location:
  • Phone: 478-751-0367
  • Fax:
Mailing address:
  • Phone: 478-751-0367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number90516
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: