Individual
MS. LISA BAZEMORE RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3650 STEVE REYNOLDS BLVD, KAISER PERMANENTE GWINNETT MEDICAL CENTER, DULUTH, GA 30096-4506
(205) 934-4794
Mailing address
3495 PIEDMONT RD NE, NINE PIEDMONT CENTER, ATLANTA, GA 30305-1717
(404) 364-7070
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
068548
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/29/2008
Last updated
01/10/2022
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