MEDICARE: WHITNEY KATHRYN RIVKIN PA-C

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	363AM0700X	Medical Physician Assistant	6514	GA

General Provider Information

NPI Number	:	1609128628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY KATHRYN RIVKIN PA-C

Provider Business Mailing Address
First Line	:	3646 CHAMBLEE TUCKER RD STE D
Second Line	:
City	:	CHAMBLEE
State	:	GA
Zip	:	30341-4406
Country	:	US
Telephone Number	:	770-493-6767
Fax Number	:	770-493-6769

Provider Business Practice Location Address
First Line	:	3646 CHAMBLEE TUCKER RD STE D
Second Line	:
City	:	CHAMBLEE
State	:	GA
Zip	:	30341-4406
Country	:	US
Telephone Number	:	770-493-6767
Fax Number	:	770-493-6769

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

Provider Enumeration Date	:	10/15/2012
Last Update Date	:	11/05/2019

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