Healthcare Provider Details

I. General information

NPI: 1053347625
Provider Name (Legal Business Name): JANICE DENISE IVERY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 10/04/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 UPPER RIVERDALE RD SW STE K
RIVERDALE GA
30274-2584
US

IV. Provider business mailing address

418 SAWMILL TRCE
HAMPTON GA
30228-1301
US

V. Phone/Fax

Practice location:
  • Phone: 404-779-2059
  • Fax: 678-935-0790
Mailing address:
  • Phone: 404-217-9952
  • Fax: 404-372-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN125446
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: