Provider Demographics
NPI:1235797408
Name:RIVERS, OCTAVIA (CNA)
Entity Type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:
Last Name:RIVERS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 TENNESSEE AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-3118
Mailing Address - Country:US
Mailing Address - Phone:912-436-2397
Mailing Address - Fax:
Practice Address - Street 1:2204 TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-3118
Practice Address - Country:US
Practice Address - Phone:912-436-2397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028869795376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide