MEDICARE: DR. JANET BIVENS M.D.

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	207Q00000X	Family Medicine Physician	GA 032410	GA

General Provider Information

NPI Number	:	1659483733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANET BIVENS M.D.

Provider Business Mailing Address
First Line	:	4424 HUGH HOWELL RD STE D
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-4905
Country	:	US
Telephone Number	:	404-692-4466
Fax Number	:	844-572-7080

Provider Business Practice Location Address
First Line	:	4424 HUGH HOWELL RD STE D
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-4905
Country	:	US
Telephone Number	:	404-692-4466
Fax Number	:	844-572-7080

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	05/05/2021

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