Provider Demographics
NPI:1467121772
Name:RIVERA, LAUREN D (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:D
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 SPRING ST STE 230
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2195
Mailing Address - Country:US
Mailing Address - Phone:478-633-1547
Mailing Address - Fax:478-633-7929
Practice Address - Street 1:781 SPRING ST STE 230
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2195
Practice Address - Country:US
Practice Address - Phone:478-633-1547
Practice Address - Fax:478-633-7929
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12914363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant