Provider Demographics
NPI:1508975368
Name:RIVELL, MARIA J (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:J
Last Name:RIVELL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3614 J DEWEY GRAY CIR STE B
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6512
Mailing Address - Country:US
Mailing Address - Phone:706-504-4651
Mailing Address - Fax:706-504-4639
Practice Address - Street 1:3651 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6521
Practice Address - Country:US
Practice Address - Phone:706-504-4651
Practice Address - Fax:706-504-4639
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA029294103TC0700X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF03585Medicare UPIN
GA26BDCVMMedicare ID - Type Unspecified