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General NPI Number Information
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NPI Number | 1851915631
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Entity Type | Individual
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Provider Name | LILIAN PEREIRA
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Gender | Female
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 01/06/2023
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Provider Practice Location Address
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Address Line | BETHESDA MEDICAL GROUP, LLC 9280 HWY 5 - SUITE D
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City | DOUGLASVILLE
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State | GA
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Zip | 30134
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Country | US
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Telephone | 770-328-6398
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Fax | 404-443-0690
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Provider Business Mailing Address
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Address Line | 9280 HIGHWAY 5 STE D
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-1501
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Country | US
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Telephone | 770-328-6398
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Fax | 404-443-0690
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 264080
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | RN264080
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License Number State | GA
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