Provider Demographics
NPI:1043877269
Name:WILLIAM J RIVERS III MD LLC
Entity type:Organization
Organization Name:WILLIAM J RIVERS III MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JACOCKS
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:770-579-9000
Mailing Address - Street 1:3225 SHALLOWFORD RD STE 500
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-7024
Mailing Address - Country:US
Mailing Address - Phone:770-579-9000
Mailing Address - Fax:888-844-0784
Practice Address - Street 1:3225 SHALLOWFORD RD STE 500
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-7024
Practice Address - Country:US
Practice Address - Phone:770-579-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty