Provider Demographics
NPI:1235994757
Name:RIVERS, MELANIE MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:MARIE
Last Name:RIVERS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 FANNIN INDUSTRIAL PARK
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-4191
Mailing Address - Country:US
Mailing Address - Phone:706-309-5500
Mailing Address - Fax:
Practice Address - Street 1:405 FANNIN INDUSTRIAL PARK
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-4191
Practice Address - Country:US
Practice Address - Phone:706-309-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN234827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily