Provider Demographics
NPI:1902495179
Name:BIVINS ENTERPRISE, LLC
Entity Type:Organization
Organization Name:BIVINS ENTERPRISE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:FANNING
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:404-820-0964
Mailing Address - Street 1:5486 SOMERSBY PKWY
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-5512
Mailing Address - Country:US
Mailing Address - Phone:140-482-0096
Mailing Address - Fax:
Practice Address - Street 1:30 ROSEMOORE DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-7065
Practice Address - Country:US
Practice Address - Phone:404-820-0964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care