Provider Demographics
NPI:1629786892
Name:RIVERS, JANET DENISE
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:DENISE
Last Name:RIVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 BILL BROWN RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:GA
Mailing Address - Zip Code:31321-4452
Mailing Address - Country:US
Mailing Address - Phone:912-601-4779
Mailing Address - Fax:
Practice Address - Street 1:144 BILL BROWN RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:GA
Practice Address - Zip Code:31321-4452
Practice Address - Country:US
Practice Address - Phone:912-601-4779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA22083411374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide