Organization
RIVERSTONEMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PEGGY NIECE TRIGG RN (CREDENTIALING MANAGER)
(706) 632-8787
Entity
Organization
Contact information
Practice address
101 RIVERSTONE VISTA, BLUE RIDGE, GA 30513-6648
(706) 632-4400
(706) 632-3585
Mailing address
101 RIVERSTONE VIS, BLUE RIDGE, GA 30513-6648
(706) 632-4400
(706) 632-3585
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
002589
GA
207N00000X
Dermatology Physician
56316
GA
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
56316
GA
363A00000X
Physician Assistant
004460
GA
363L00000X
Nurse Practitioner
043489
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300029865F
—
GA
05
—
890252M
—
NC
Enumeration date
01/31/2007
Last updated
05/18/2015
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