Physician Compare National (NPI:1639468580)

HEALTHCARE PROVIDER: WILLIAM JACOCKS RIVERS III M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1639468580
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9537306832
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20151012001557
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RIVERS
	Individual professional last name
Provider First Name	WILLIAM
	Individual professional first name
Provider Middle Name	JACOCKS
	Individual professional middle name
Provider Name Suffix Text	III
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	MERCER UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2011
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL MEDICINE AND REHABILITATION
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	125 TOWNPARK DR NW
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 300
	Group Practice or individual's line 2 address
City	KENNESAW
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	301443231
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y