Provider Demographics
NPI:1306207105
Name:RIVERA, MARCOS
Entity type:Individual
Prefix:
First Name:MARCOS
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5020 EMERALD ISLE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-4841
Mailing Address - Country:US
Mailing Address - Phone:706-570-0316
Mailing Address - Fax:
Practice Address - Street 1:1880 BEAVER RIDGE CIR
Practice Address - Street 2:SUITE D
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-3833
Practice Address - Country:US
Practice Address - Phone:404-320-6018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other