Healthcare Provider Details

I. General information

NPI: 1942294848
Provider Name (Legal Business Name): CARLOS A RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 WATERS AVE STE C8
SAVANNAH GA
31406-3825
US

IV. Provider business mailing address

7505 WATERS AVE STE C8
SAVANNAH GA
31406-3825
US

V. Phone/Fax

Practice location:
  • Phone: 912-352-2606
  • Fax: 912-352-0623
Mailing address:
  • Phone: 912-352-2606
  • Fax: 912-352-0623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number34456
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number34456
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number34456
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number34456
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number34456
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number34456
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number34456
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: