Provider Demographics
NPI:1659483733
Name:BIVENS, JANET (MD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:
Last Name:BIVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 HUGH HOWELL RD STE D
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4905
Mailing Address - Country:US
Mailing Address - Phone:404-692-4466
Mailing Address - Fax:844-572-7080
Practice Address - Street 1:4424 HUGH HOWELL RD STE D
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4905
Practice Address - Country:US
Practice Address - Phone:404-692-4466
Practice Address - Fax:844-572-7080
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA 032410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00416138AMedicaid
GAD16963Medicare UPIN