MEDICARE: ISAIAH LAWERANCE RIVERA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	111643	GA

General Provider Information

NPI Number	:	1407507429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAIAH LAWERANCE RIVERA MD

Provider Business Mailing Address
First Line	:	1000 MEDICAL CENTER BLVD
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-7694
Country	:	US
Telephone Number	:	678-312-1000
Fax Number	:	678-312-3282

Provider Business Practice Location Address
First Line	:	UNIVERSITY OF TENNESSEE 920 MADISON AVENUE SUITE 447
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38163-1020
Country	:	US
Telephone Number	:	615-284-3387
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2022
Last Update Date	:	03/25/2026

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