MS. LISA BAZEMORE RIVERA (NPI# 1730332131) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730332131 |
| Entity Type | Individual |
| Full Name | MS. LISA BAZEMORE RIVERA |
| Credential | MD |
| Practice Address |
3650 Steve Reynolds Blvd. Kaiser Permanente Gwinnett Medical Center Duluth GA 30096 |
| Mailing Address |
3495 Piedmont Road, Ne Nine Piedmont Center Atlanta GA 30305 |
| Practice Telephone | 2059344794 |
| Mailing Telephone | 4043647070 |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2014-07-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
068548 | GA | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083074413 | Lisa Marie Rivera | Case Manager/Care Coordinator | 5683 Tucson Dr, #1, San Jose, CA 95118-3217 | 2016-02-26 |
| 1811352784 | Lisa Marie Rivera | Pharmacist | 1600 Mallard Cir, Mansfield, TX 76063-4082 | 2015-12-20 |
| 1366427395 | Lisa Katherine Rivera | Pathology | 590 Moffet St, Bldg 4077, Joint Base Pearl Harbor-hickam, Honolulu, HI 96853-5168 | 2005-12-13 |
| 1780675868 | Lisa Jan Rivera | Social Worker | 17 W Merrick Rd, Freeport, NY 11520-3873 | 2005-10-28 |
| 1245852631 | Lisa J Rivera | Nurse Practitioner | 901 W Main St, Freehold, NJ 07728-2549 | 2020-05-08 |
| 1992337729 | Lisa Maureen Rivera | Family Medicine | 70 Main St, Florence, MA 01062-1487 | 2020-02-10 |
| 1598233322 | Lisa Rivera | Occupational Therapist | 11690 Neelsville Church Rd, Germantown, MD 20876-4127 | 2018-11-09 |
| 1750856449 | Lisa Rivera | Case Manager/Care Coordinator | 3167 Fulton Rd, Cleveland, OH 44109-1465 | 2018-10-09 |
| 1437522406 | Lisa Rivera | Dental Hygienist | 4000 Coast Guard Blvd, Portsmouth, VA 23703-2135 | 2015-11-12 |
| 1033581749 | Lisa Rivera | Counselor | 1225 Ken Pratt Blvd, Ste. 200, Longmont, CO 80501-6518 | 2015-10-21 |
| Street Address |
3650 STEVE REYNOLDS BLVD. KAISER PERMANENTE GWINNETT MEDICAL CENTER |
| City | DULUTH |
| State | GA |
| Zip Code | 30096 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659360568 | William Moten Craven | Orthopaedic Surgery | 3650 Steve Reynolds Blvd., Kaiser Permanente Gwinnett Medical Center, Duluth, GA 30096 | 2005-10-14 |
| 1851719710 | Theresa Welles | Psychologist | 3650 Steve Reynolds Blvd., Duluth, GA 30096 | 2014-03-28 |
| 1275805970 | Frances Ann Lanza | Social Worker | 3650 Steve Reynolds Blvd., Kaiser Permanente Gwinnett Medical Center, Duluth, GA 30096 | 2012-01-27 |
| 1750676060 | Andrea Giardina Hill | Optometrist | 3650 Steve Reynolds Blvd., Kaiser Permanente Gwinnett Medical Center, Duluth, GA 30096 | 2011-06-15 |
| 1588977557 | Ammar Divan | Anesthesiology | 3650 Steve Reynolds Blvd., Kaiser Permanente Gwinnett Medical Center, Duluth, GA 30096 | 2010-07-20 |
| 1639493224 | Nancy Huynh | Specialist | 3650 Steve Reynolds Blvd., Kaiser Permanente Gwinnett Medical Center, Duluth, GA 30096 | 2010-03-25 |
| 1891957528 | Ana Silvia Grosso | Pediatrics | 3650 Steve Reynolds Blvd., Kaiser Permanente Gwinnett Medical Center, Duluth, GA 30096 | 2008-06-25 |
| 1316107253 | Hernan Dario Urrego | Surgery | 3650 Steve Reynolds Blvd., Kaiser Permanente Gwinnett Medical Center, Duluth, GA 30096 | 2008-06-13 |
| 1417134545 | Jada R. Olderman | Pediatrics | 3650 Steve Reynolds Blvd., Kaiser Permanente Gwinnett Medical Center, Duluth, GA 30096 | 2008-01-31 |
| 1508042268 | Carolyn Bray Hebson | Specialist | 3650 Steve Reynolds Blvd., Kaiser Permanente Gwinnett Medical Center, Duluth, GA 30096 | 2008-01-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922615897 | Georgia Eye Optical, LLC | Ophthalmology | 3800 Pleasant Hill Rd Ste 3, Duluth, GA 30096 | 2020-09-25 |
| 1568090868 | Positive Behavior Services, Inc | Behavior Technician | 3765 Crestwood Pkwy Nw, Duluth, GA 30096 | 2020-03-31 |
| 1861031940 | Elizabeth Ashley Edouard | Counselor | 3464 Duluth Hwy 120, Duluth, GA 30096 | 2020-01-06 |
| 1245701044 | Kathryn Irene Vaughn | Social Worker | 3968 Mainsail Court, Duluth, GA 30096 | 2018-12-06 |
| 1083184626 | Aica Orthopedics, P.C. | Orthopaedic Surgery | 3775 Venture Drive Bldg F, Duluth, GA 30096 | 2018-11-27 |
| 1245709799 | Positive Impact Health Centers, Inc. | Pharmacy | 3350 Breckinridge Blvd, Suite 200a, Duluth, GA 30096 | 2018-11-14 |
| 1235611724 | Katherine Winstead Knott | Counselor | 3460 Summit Ridge Parkway, Suite 503, Duluth, GA 30096 | 2018-08-31 |
| 1710467857 | Envision Optics LLC | Optometrist | 1943 Pleasant Hill Rd, Duluth, GA 30096 | 2018-08-17 |
| 1104314202 | Erin Mckernan Scupham | Chiropractor | 3820 Pleasant Hill Rd. Ne, Suite 4, Duluth, GA 30096 | 2018-04-25 |
| 1053839456 | Rogers Bridge Pediatric Therapy, LLC | Clinic/Center | 2845 Summercrest Ln, Duluth, GA 30096 | 2017-09-06 |
| Find all providers in zip 30096 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497905913 | Dong Wang | Psychiatry & Neurology | 3790 Pleasant Hill Rd Ste 250, Duluth, GA 30096-5150 | 2008-09-20 |
| 1174718027 | Roberta Ruth Hallquist | Psychiatry & Neurology | 2812 E Superior St, Duluth, MN 55812-2345 | 2007-09-12 |
| 1760528418 | Amber Irene Erickson | Psychiatry & Neurology | 400 E. 3rd St, Smdc Medical Center - Duluth Clinic, Duluth, MN 55805 | 2007-01-29 |
| 1912903485 | Philip R Kennedy | Psychiatry & Neurology | 3400 Mcclure Bridge Rd, Suite D401, Duluth, GA 30096-6675 | 2005-06-21 |
| 1588669253 | Douglas W Kaplan | Psychiatry & Neurology | 1012 E 2nd St, Duluth, MN 55805-2200 | 2005-06-17 |
| 1518346188 | Jacob Andrew Hvidston | Psychiatry & Neurology | 400 E 3rd St, Duluth, MN 55805-1951 | 2015-05-28 |
| 1679961551 | St. Luke's Hospital of Duluth | Psychiatry & Neurology | 1012 E 2nd St, Duluth, MN 55805-2200 | 2014-12-31 |
| 1922417633 | Georgia Neurodiagnostic & Treatment Center LLC. | Psychiatry & Neurology | 3790 Pleasant Hill Rd Ste 250, Duluth, GA 30096-5150 | 2014-08-06 |
| 1013203033 | Chena Margaret-filizetti Beauduy | Psychiatry & Neurology | 400 E 3rd St, Essentia Health Duluth Clinic, Duluth, MN 55805-1951 | 2011-06-28 |
| 1548572647 | Aboubakar Sharaf | Psychiatry & Neurology | 400 E 3rd St, Essentia Health Duluth Clinic, Duluth, MN 55805-1951 | 2010-07-06 |
| Find all providers in DULUTH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.