Provider Demographics
NPI:1639468580
Name:RIVERS, WILLIAM JACOCKS III (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JACOCKS
Last Name:RIVERS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 SHALLOWFORD RD STE 500
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-7024
Mailing Address - Country:US
Mailing Address - Phone:770-579-9000
Mailing Address - Fax:888-844-0784
Practice Address - Street 1:3225 SHALLOWFORD RD STE 500
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-7024
Practice Address - Country:US
Practice Address - Phone:770-579-9000
Practice Address - Fax:888-844-0784
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA74337208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation