Provider Demographics
NPI:1851915631
Name:PEREIRA, LILIAN
Entity Type:Individual
Prefix:
First Name:LILIAN
Middle Name:
Last Name:PEREIRA
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 1:9280 HIGHWAY 5 STE D
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-1501
Mailing Address - Country:US
Mailing Address - Phone:770-328-6398
Mailing Address - Fax:404-443-0690
Practice Address - Street 1:BETHESDA MEDICAL GROUP, LLC
Practice Address - Street 2:9280 HWY 5 - SUITE D
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134
Practice Address - Country:US
Practice Address - Phone:770-328-6398
Practice Address - Fax:404-443-0690
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA264080363LF0000X
GARN264080363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily